Application of Thoracoscopy Combined With Laparoscopy for Radical Esophagectomy Based on Membrane Anatomy Theory / 中国微创外科杂志

Objective To investigate the feasibility and clinical significance of membrane anatomy theory in the application of thoracoscopic and laparoscopic radical esophageal resection.Methods A retrospective analysis was performed on 142 cases of thoracoscopic and laparoscopic radical esophagectomy based on membrane anatomy theory from December 2018 to October 2021.The esophageal mesangium,esophageal cancer,and nerves,blood vessels,lymphatic system,adipose tissue,upper stomach,left mesangium,and left gastric lymph nodes in the esophageal mesangium were removed as a whole.During the surgery,the space containing loose connective tissue around the esophagus was seen to be the esophageal fascial fusion space.The first 10 cases were labeled with nanocarbon tracer markers,showing esophageal lymphatic drainage to the left gastric lymph node.Results All the 142 patients had smooth surgery.The operation time was 150-230 min(mean,184.6±21.3 min),the intraoperative blood loss was 20-100 ml(mean,46.7±16.8 ml),the number of lymph nodes dissected was 12-41(mean,23.5±7.3),and the positive lymph nodes were found in 97 cases.The postoperative chest drainage time was3-10 d(mean,7.1±2.5 d),the postoperative oral intake time was 5-10 d(mean,7.6±1.7 d),and the total hospital stay was 9-20 d(mean,14.0±4.6 d).The total incidence of postoperative complications was 21.8%(31/142),including 7 cases(4.9%)of anastomotic leakage,9 cases(6.3%)of anastomotic stenosis,9 cases(6.3%)of hoarseness,and6 cases(4.2%)of residual gastritis.There was no postoperative bleeding,chyllevial leakage,infection,or death within 30 d after surgery.The follow-ups of the 142 patients lasted for 11-35 months,with a median of 26 months,and there was no recurrence and death.Conclusions There is a mesangial structure that constitutes an"envelope"around the esophagus.The membrane anatomy theory is suitable for the treatment of esophageal cancer,and radical resection of esophageal cancer based on the theory is safe,effective,and feasible.

Acupuncture with Manipulation for Lumbar Disc Herniation in Remission of 50 Cases：A Randomized Controlled Trial / 中医杂志

ObjectiveTo evaluate the clinical effectiveness and safety of acupuncture with manipulation for lumbar disc herniation in remission period. MethodsOne hundred and four patients with lumbar disc herniation in remission were randomly divided into a treatment group and a control group， with 52 cases in each group. Treatment group applied acupuncture with manipulation of pointing， pulling， and shaking. Acupoints were selected as lumbar Jiaji （EX-B2， bilateral）， Ashi point， Shenshu （BL 23， bilateral）， Huantiao （GB 30， bilateral）， Weizhong （BL 40， opposite side of the affected area）， Chengshan （BL 57， opposite side of the affected area）. The control group applied lumbar traction plus acupoint ultrasonic pulse penetration therapy （acupoints selection same as the treatment group）； 20 minutes each time， 3 times a week， a total of 3 weeks for both groups. The primary outcome was the improvement rate of lumbar disc herniation symptoms and signs， which was calculated at 1 week of treatment， 3 weeks of treatment， 1 month follow-up， and 3 months follow-up， respectively； the secondary outcome were the Japanese Orthopaedic Association （JOA） scores， Visual Analogue Scale （VAS） scores， and Oswestry Disability Index （ODI） scores （including ODI total scores， sitting scores and standing scores）， which were evaluated before treatment， 1 week of treatment， 3 weeks of treatment， 1 month follow-up， and 3 months follow-up； clinical effectiveness was assessed at 3 months follow-up； and the occurrence of adverse events in the participants， as well as blood routine， urine routine， stool routine， and electrocardiograms before and after the treatment were recorded to evaluate safety. ResultsTwo patients from each group fell out， and 50 patients of each group were included in the outcome analysis ultimately. The scores of lumbar disc herniation symptoms and signs improved more in the treatment group than in the control group at 1 week of treatment， 3 weeks of treatment， 1 month follow-up and 3 months follow-up （P＜0.01）. The JOA scores of participants in both groups at 1 week of treatment， 3 weeks of treatment， 1 month follow-up and 3 months follow-up were higher than those before treatment in the same group， and the VAS scores， ODI total scores， ODI sitting scores and standing scores were significantly lower than those before treatment in the same group （P＜0.05）， and the JOA scores of patients in the treatment group were higher than those of the control group at all time points， and the VAS scores， ODI total scores， ODI sitting scores and standing score were lower than those of the control group （P＜0.05）. At the 3 months follow-up， the excellent rate of the treatment group was 70.00% （35/50） better than that of the control group， which was 50.00% （25/50） （P＜0.05）. There were no abnormalities in blood， urine， stool routines and electrocardiograms before and after treatment in both groups， and no adverse events occurred. ConclusionAcupuncture with manipulation of pointing， pulling， and shaking for treating patients with lumbar disc herniation in remission has a better safety on pain relief and improving quality of life， and the effectiveness is better than lumbar traction plus acupoint ultrasonic pulse penetration therapy.

Efficacy of subcutaneous negative pressure drainage device in the prevention of surgical site infections of superficial incisions in the open surgery of the lower gastrointestinal tract / 国际外科学杂志

Objective:To investigate the role of subcutaneous negative pressure drainage device in the prevention of surgical site infections (SSI) of superficial incisional in lower digestive tract open surgeries.Methods:Clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital, Capital Medical University from October 2018 to June 2020 was analyzed by a propensity score matching (PSM), and the clinical data of 104 patients receiving open surgeries on lower digestive tract at Beijing Friendship Hospital, Capital Medical University from February to December 2021 was analyzed by a randomized controlled trial (RCT). Chi-square tests were conducted to analyze the association of subcutaneous negative pressure drainage device with SSI of superficial incisional. Univariate and multivariate Logistic regression analysis were used to identify the risk factors for SSI in superficial incisions.Results:Patients with subcutaneous negative pressure drainage device encounter significantly less SSI of superficial incisional in both the PSM study ( P=0.007) and the RCT study ( P=0.049). In the PSM study, the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage ( Puni=0.012, Pmulti=0.009) and postoperative anastomosis leak ( Puni=0.054, Pmulti=0.034). In the RCT study, the independent risk factors for SSI of superficial incisional via univariate and multivariate Logistic regression analysis were absence of subcutaneous drainage ( Puni=0.061, Pmulti=0.017), eldly ( Puni=0.076, Pmulti=0.032), long incision ( Puni=0.078, Pmulti=0.040). Conclusion:Subcutaneous negative pressure drainage device can significantly reduce SSI of superficial incisional in lower digestive tract open surgeries.

Correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline / 中华健康管理学杂志

Objective:To analyze the correlation between ambulatory blood pressure variability and the progression of subjective cognitive decline (SCD).Methods:In this prospective observational study, the overall sampling method was used to continuously select 100 patients with SCD in the Department of Neurology, Changshu First People′s Hospital and Changshu Xinzhuang People′s Hospital from January 1 2016 to June 30 2017. The baseline demographic characteristics of the patients were collected. The Chinese version of SCD-Q9 questionnaire was used to self-evaluate SCD, and the Montreal Cognitive Assessment Scale (MoCA) was used to evaluate objective cognitive impairment. All patients received 24 h ambulatory blood pressure monitoring, and 24 h systolic coefficient of variation (SCV) and diastolic coefficient of variation (DCV) were calculated. The follow-up period was 4 years after the first visit, and the MoCA scale was evaluated once a year. Finally, 83 patients completed the follow-up and were included in this study. According to the MoCA score at the end of follow-up (<26 or ≥26), the patients were divided into progression group (39 cases) and non-progression group (44 cases). The difference of MoCA score between baseline and last follow-up was calculated in the progression group. The difference in demographic characteristics between the two groups was compared with χ2 test. The difference of 24 h SCV and 24 h DCV between the two groups were compared by rank sum test. The correlation between 24 h SCV and MoCA score difference or SCD-Q9 score in the progression group were tested by multiple linear regression analysis. Results:The 4-year progression rate of SCD patients was 46.99% (39/83). There was no significant differences in baseline age, gender, education level, medical history, smoking history, SCD-Q9 score and MoCA score between the progressive group and the non-progressive group (all P>0.05). The 24 h SCV in the progressive group was significantly higher than that in the non-progressive group [13.4% (9.9%, 15.6%) vs 10.9% (9.7%, 12.7%), U=594.50, P=0.016]. There was no significant difference in 24 h DCV between the two groups ( P>0.05). In progressive group, the 24 h SCV was negatively correlated with MoCA score difference ( r=-0.368, P=0.021). Conclusion:There is a correlation between ambulatory blood pressure variability and SCD progression, high 24 h SCV may be one of the factors of SCD progression and has certain predictive value.

Intraoperative body temperature and emergence delirium in elderly patients after non-cardiac surgery: A secondary analysis of a prospective observational study / 中华医学杂志(英文版)

BACKGROUND@#Emergence delirium (ED) is a kind of delirium that occured in the immediate post-anesthesia period. Lower body temperature on post-anesthesia care unit (PACU) admission was an independent risk factor of ED. The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.@*METHODS@#This study was a secondary analysis of a prospective observational study. Taking baseline body temperature as a reference, intraoperative absolute and relative temperature changes were calculated. The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference. ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.@*RESULTS@#A total of 874 patients were analyzed with a mean age of 71.8 ± 5.3 years. The incidence of ED was 38.4% (336/874). When taking 36.0°C, 35.5°C, and 35.0°C as thresholds, the incidences of absolute hypothermia were 76.7% (670/874), 38.4% (336/874), and 17.5% (153/874), respectively. In multivariable logistic regression analysis, absolute hypothermia (lowest value <35.5°C) and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age, education, preoperative mild cognitive impairment, American Society of Anesthesiologists grade, duration of surgery, site of surgery, and pain intensity. Relative hypothermia (decrement >1.0°C from baseline) and its cumulative duration were also associated with an increased risk of ED, respectively. When taking the relative increment >0.5°C as a threshold, the incidence of relative hyperthermia was 21.7% (190/874) and it was associated with a decreased risk of ED after adjusting above confounders.@*CONCLUSIONS@#In the present study, we found that intraoperative hypothermia, defined as either absolute or relative hypothermia, was associated with an increased risk of ED in elderly patients after non-cardiac surgery. Relative hyperthermia, but not absolute hyperthermia, was associated with a decreased risk of ED.@*REGISTRATION@#Chinese Clinical Trial Registry (No. ChiCTR-OOC-17012734).

Protective effect of pre-perfusion with improved St.Thomas solution on skeletal muscle ischemia-reperfusion injury in dogs / 中华显微外科杂志

Objective:To explore the protective effect and mechanism of improved St. Thomas solution on canine skeletal muscle ischemia-reperfusion injury (IRI).Methods:Between March 2021 and September 2021, in the experimental operating room at the Air Force Hospital of the PLA Eastern Theater Command, 16 Beagles were randomly divided into control group, IRI group, IRI+NS group, and improved St. Thomas group, 4 in each group. The canine skeletal muscle IRI model was established, and the canine vital signs were monitored by pre-perfusion with improved St. Thomas perfusate [potassium chloride (KCl), magnesium sulfate (MgSO 4), and NaHCO 3 (pH adjusted)]. The pathological damage of canine skeletal muscle was explored by hematoxylin eosin (HE) staining, electron microscope detection and tissue wet/dry weight ratio, and blood vessel density. Hypoxia performances were detected by labeling blood vessels and hypoxia-inducible factor-1α (HIF-1α). The IRI model of L6 rat myoblasts was established, and the components of St. Thomas perfusion solution were pre incubated to explore the effect on the inhibition of cell proliferation. And by detecting reduced nicotinamide adenine dinucleotide phosphate (NADPH), F2 isoprostane (F2-isoprostane), interleukin 1β(IL-1β), tumour necrosis factor alpha (TNF-α), myeloperoxide enzyme (MPO), glutathione peroxidase (GSH-Px), etc. to explore its protective mechanism. Statistical software SPSS 23.0 was used for statistical analysis, A P<0.05 was set as statistically significant. Results:In the improved St. Thomas group, the vital signs of the dogs were relatively stable, the amount of maintained dopamine was less, the histopathological structure of the gastrocnemius muscle tended to be intact, the swelling of tissue cells and mitochondria was significantly relieved, and the tissue wet/dry weight ratio was less than that in the IRI group ( P=0.046). Pre-incubated with therapeutic doses of MgSO 4 or NaHCO 3, the proliferation rate of L6 cells was higher than that of IRI group ( P<0.01, P=0.005), NADPH ( P=0.004, P=0.001), F2-isoprostane ( P<0.01, P=0.01), IL-1β ( P=0.02, P=0.015), TNF-α ( P<0.01, P<0.01), MPO ( P<0.01, P<0.01) were all lower than those in the IRI group, except GSH-Px that was higher than what in the IRI group ( P<0.01). Conclusion:Pre-perfusion of the improved St. Thomas solution can stabilise the vital signs of dogs in a short period of time. The solution can improve the state of skeletal muscle cells, improve tissue hypoxia, and reduce the damage of skeletal muscle tissue cells through anti-inflammatory and anti-oxidative stress.

Therapeutic effects of dialectical addition and subtraction treatment based on self-made Qufeng Zhike Decoction on cough caused by wind dryness invading the lung / 中国基层医药

Objective:To investigate the therapeutic effects of dialectical addition and subtraction treatment based on self-made Qufeng Zhike Decoction on cough caused by wind dryness invading the lung. Methods:Thirty patients with cough after catching a cold who were admitted by Huainan Hospital of Traditional Chinese Medicine from May 2021 to May 2022 were included in this study. These patients were treated with self-made Qufeng Zhike Decoction (first decocting the ochre for 30 minutes, then decocting inula flower in cloth bags, or traditional Chinese medicine drug granules for drinking with boiled warm water), 1 dose per day, 5 doses in total at first diagnosis. During the follow-up visit, patients were given an dialectical addition and subtraction treatment according to the improvement of cough. Five days of dialectical addition and subtraction treatment were taken as one course of treatment, and two or three courses of treatment were used. Therapeutic effects and adverse reactions were recorded. Scores of cough, expectoration and pharyngeal itching before and 15 days after treatment were recorded. Results:All 30 patients actively cooperated with the treatment. Among 30 patients, treatment was remarkably effective in 19 patients, effective in 9 patients, and ineffective in 2 patients, with a total response rate of 93.33% (28/30). Among 30 patients, two complained of mild stomach discomfort (relieved after taking medicine 1 hour after a meal). No obvious adverse reactions were found in the remaining patients. Compared with before treatment, scores of cough, expectoration and pharyngeal itching were significantly decreased after treatment [cough: (2.38 ± 0.51) points vs. (1.00 ± 0.85) points; expectoration: (0.88 ± 0.54) points vs. (0.29 ± 0.08) points; pharyngeal itching: (0.98 ± 0.67) points vs. (0.65 ± 0.33) points, t = 2.36, 2.98, 2.01, all P < 0.05]. Conclusion:Dialectical addition and subtraction treatment based on self-made Qufeng Zhike Decoction for treatment of cough caused by wind dryness invading the lung has a promising curative effect, without obvious adverse reactions.

Therapeutic Efficacy and Safety of Different Doses of Secukinumab in the Treatment of Medium and Severe Ankylosing Spondylitis ：A Meta-analysis / 中国药房

OBJECTIVE：To evaluate therapeutic e fficacy and safety of differen t doses of Secukinumab in the treatment of medium and severe ankylosing spondylitis （AS）， and to provide evidence-based reference for clinical treatment of AS. METHODS： Retrieved from Medline ， PubMed， Cochrane Library， Embase， VIP， CJFD， Wanfang database andpu- ClinicalTrials.gov， during the inception to March 2020， xiaofeng1205@outlook.com randomized controlled trials （RCTs）about different doses of secukinumab （75， 150， 300 mg） versus placebo in the treatment of medium and severe AS were collected. After data extraction of clinical studies met the inclusion criteria ，quality evaluation with Cochrane risk bias evaluation tool 5.1.0，Rev Man 5.3 statistical software was used for Meta-analysis of therapeutic efficacy [in the international society for the evaluation of spondyloarthritis scale ，the proportion of 20％ patients improved （ASAS20）；ASAS40；among 6 routine clinical areas related to AS，the scores of at least 5 areas improved by at least 20％，and there was no patients receiving treatment due to deterioration in other areas （ASAS 5/6）；remission value of Bath ankylosing spondylitis disease activity index （BASDAI）from baseline to 16th week，the proportion of the patients with the international society for the evaluation of ankylosing spondyloarthritis （ASAS PR ） score no higher than 2 in the 4 ASAS fields within the specified time] and safety [the incidence of withdrawal from treatment due to ADR，the incidence of serious ADR ，the incidence of general ADR （nasopharyngitis，headache，diarrhea）]. RESULTS ：A total of 5 RCTs were included ，involving 1 624 patients. Meta-analysis showed that ASAS 20 [total：OR＝2.62，95％CI（2.14，3.20），P＜ 0.000 01；75 mg：OR＝2.63，95％CI（1.28，5.40），P＝0.008；150 mg：OR＝2.58，95％CI（2.01，3.32），P＜0.000 01；300 mg：OR＝2.63，95％CI（1.37，5.06），P＝0.004]，ASAS40 [total：OR＝2.82，95％CI（2.13，3.74），P＜0.000 01；75 mg：OR＝ 3.14，95％CI（1.86，5.31），P＜0.000 1；150 mg：OR＝2.79，95％CI（1.85，4.20），P＜0.000 01；300 mg：OR＝2.73，95％CI （1.33，5.58），P＝0.006]，ASAS5/6 [total：OR＝3.82，95％CI（2.61，5.59），P＜0.000 01；75 mg：OR＝5.59，95％CI（3.29， 9.49），P＜0.000 01；150 mg：OR＝3.45，95％CI（2.08，5.70），P＜0.000 01；300 mg：OR＝3.85，95％CI（1.75，8.47），P＝ 0.000 8]，ASAS PR [total ：OR＝4.69，95％CI（3.07，7.16），P＜0.000 01；75 mg：OR＝5.48，95％CI（2.50，11.99），P＜0.000 1； 150 mg：OR＝3.71，95％CI（2.19，6.29），P＜0.000 01；300 mg：OR＝20.0，95％CI（2.58，155.14），P＝0.004] in trial group was significantly higher than control group ；BASDAI improvement [total ：WMD＝－1.15，95％CI（－1.50，－0.79），P＜0.000 01； 75 mg：WMD＝－1.40，95％CI（－2.08，－0.72），P＜0.000 1；150 mg：WMD＝－1.03，95％CI（－1.52，－0.54），P＜ 0.000 1；300 mg：WMD＝－1.20，95％CI（－2.03，－0.37），P＝0.005] of trial group were significantly higher than those of control group ，with statistical significance. The total incidence of nasopharyngitis in trial group [OR ＝1.77，95％CI（1.22，2.57）， P＝0.003] and 150 mg dose subgroup [OR ＝1.84，95％CI（1.18，2.86），P＝0.007] was significantly higher than control group ， without significant difference in other safety indexes among total and different dose subgroups （P＞0.05）. CONCLUSIONS ：75 mg，150 mg and 300 mg of secukinumab are all effective and well tolerated for medium and severe AS patients ，and 150 mg of secukinumab may increase the incidence of nasopharyngitis.

Clinical observation of the therapeutic effect of Xiaochaihu decoction addition and subtraction on cough variant asthma based on the theory of " Shaoyang as the pivot" / 中国基层医药

Objective:To explore the therapeutic effect of Xiaochaihu decoction addition and subtraction on cough variant asthma(CAV) based on the theory of " Shaoyang as the pivot" .Methods:From May 2018 to May 2019, 23 patients with CAV were selected in the Traditional Chinese Medicine Hospital of Huainan, all of whom were diagnosed as CAV by bronchodilation test.The patients were first treated with Xiaochaihu decoction addition and subtraction, 7 doses, decocting in water, oral, 1 dose per day.Add and subtract the prescriptions according to the changes of the condition.The curative effect and adverse reactions were observed, and the recurrence was observed for half a year.Results:Of 23 patients, 11 cases were obviously effective, 9 cases were effective and 3 cases were ineffective, the total effective rate was 87.0%(20/23). Course of treatment: of the 11 cases with obvious effect, 4 cases were treated for 3 weeks, 5 cases for 4 weeks, 2 cases for 5 weeks, and 9 cases with effective effect were treated for 5 weeks.It was suggested to use other treatment for 3 cases with ineffective effect after 6 weeks of treatment.No obvious adverse reactions were found in 22 patients, one patient had slight nausea, which was relieved by himself.All 23 cases were followed up for half a year, 3 cases recurred, the recurrence rate was 13.0%(3/23).Conclusion:Based on the theory of " Shaoyang as the pivot" , the treatment of CAV with Xiaochaihu decoction addition and subtraction has high clinical effective rate, low recurrence rate and no obvious adverse reactions.

Relationship between excite seeking personality and alcohol use among college students in Hunan Province / 中国心理卫生杂志

Objective: To explore the association between excite seeking personality and alcohol use, and provide reference basis for intervention measures of drinking behavior. Methods: Totally 5966 college students in 8universities [2180 males, mean age (20 ± 1) ] were selected from Hunan province by using multi-stage stratified cluster random sampling method. We Chat-based anonymous questionnaire survey was conducted by using general questionnaire, excite-seeking personality scales, alcohol questionnaire, and alcohol use disorders identification test. Results: The rate of 12-month alcohol drinking, binge drinking, hazardous and harmful drinking among college students were 47. 5％, 24. 5％, 7. 4％, respectively. High degree of excite seeking personality had more likelihood to having had alcohol drinking, binge drinking, hazardous and harmful drinking (Ps ＜ 0. 01). Excite seeking personality was an independent risk factor of 12-month alcohol drinking, binge drinking, hazardous and harmful drinking. Conclusion: It suggests that excite-seeking personality may be a related factor of alcohol drinking behavior.

Correlation between 24-h ambulatory blood pressure variability and the overall burden of cerebral small vessel disease in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the correlation between 24-h ambulatory blood pressure variability and the overall burden of cerebral small vessel disease (CSVD) in patients with acute ischemic stroke. Methods From March 2016 to December 2017, consecutive patients with acute ischemic stroke admitted to the Department of Neurology, the Affiliated Changshu Hospital of Soochow University were enrolled. The 3. 0 T-MRI was used to assess asymptomatic lacunar infarction, white matter hyperintensities, cerebral microbleeds, and enlarged perivascular spaces within 24 h after admission, and the total CSVD score (0-4) was calculated. 24-h ambulatory blood pressure monitoring was performed 24 to 72 h after admission. Ordinal logistic regression analysis was used to determine the independent correlation between the 24-h ambulatory blood pressure-related index and the total CSVD score. Results A total of 220 patients with acute ischemic stroke were enrolled. The patients were divided into five groups according to the total CSVD score. Univariate analysis showed that there were significant differences in age, homocysteine, the proportion of hypertension, as well as 24 h, daytime and nighttime mean systolic blood pressure (SBP), and coefficient of variation of daytime SBP among the 5 groups (all P < 0. 05). Ordinal logistic regression analysis showed that age (odds ratio [OR] 1. 078, 95％ confidence interval [CI] 1. 051-1. 106; P < 0. 001), 24-h mean SBP (OR 1. 043, 95％ CI 1. 026-1. 060; P < 0. 001), daytime mean SBP (OR 1. 042, 95％ CI 1. 025-1. 059; P < 0. 001), nighttime mean SBP (OR 1. 034, 95％ CI 1. 019-1. 049; P < 0. 001), and coefficient of variation of daytime SBP (OR 1. 129, 95％ CI 1. 052-1. 210; P = 0. 003) were independently correlated with the total CSVD score. Conclusions The elevated 24 h, daytime and nighttime mean SBP levels and coefficient of variation of daytime SBP are independently correlated with the severity of overall CSVD burden in patients with acute ischemic stroke.

Detection of colorectal polyps and adenomas in asymptomatic health examination population and analysis of relevant clinical factors / 国际外科学杂志

Objective To analysis the incidence and relevant clinical factors of colorectal polyps and adenomas in population of health examination.Methods Colonoscopy results and clinical data of 615 cases undergoing health examination from January 2018 to March 2019 were analyzed retrospectively in International Medical Center,Beijing Friendship Hospital,Capital Medical University.There were 436 males and 179 females,average age 47.38 years,aged 18-81 years.The clinical data contained sex,age,smoking history,drinking history,body mass index.Chi-square test and trend chi-square test were used to compare the differences of polyp detection rate and adenoma detection rate in different populations.Multivariate Logistic regression analysis were applied to explore the potential factors associated with the polyp detection rate and adenoma detection rate.Results Two hundred and forty cases (39.02％) with colorectal disease were checked out,include 206 cases(33.50％) with colorectal polyps and 138 cases(22.44％) with colorectal adenomas.In the detection rate of colorectal polyps,male were higher than female [36.70％ (160/436) vs 25.70％ (46/179),x2 =6.89,P ＜ 0.05],smokers were higher than non-smokers[42.35％ (108/255) vs 27.22％ (98/360),x2 =15.34,P ＜0.001],and drinkers were higher than non-drinkers[40.67％ (109/268) vs 27.95％ (97/347),x2 =10.98,P ＜0.05].With the increase of age,the detection rate of colorectal polyps increased significantly (x2 =24.19,P ＜ 0.001).With the increase of body mass index,the detection rate of colorectal polyps increased significantly(x2 =16.88,P ＜0.001).In the detection rate of colorectal adenoma,smokers were higher than non-smokers [28.24％ (72/255) vs 18.33 ％ (66/ 360),x2 =7.31,P ＜ 0.05],and drinkers were higher than non-drinkers [27.61 (74/268)％ vs 18.44％ (64/ 347),x2 =7.30,P ＜ 0.05].With the increase of age,the detection rate of colorectal adenoma increased significantly(x2 =15.87,P ＜ 0.001).With the increase of body mass index,the detection rate of colorectal adenoma increased significantly (x2 =13.30,P ＜ 0.001).There was no significant difference in the detection rate of colorectal adenomas between male and female [24.31％ (106/436) vs 17.88％ (32/179),x2 =3.02,P ＞ 0.05].Multivariate Logistic regression analysis showed that age increasing,body mass index increasing,smoking and alcohol consumption were risk factors for colorectal polyps and adenomas.Conclusions The detection rate of colorectal polyps and adenomas are related with sex,age,smoking,drinking and body mass index.Age increasing,body mass index increasing and smoking are the risk factors for colorectal polyps,age increasing and body mass index increasing are the risk factors for colorectal adenomas.

Effects of aerobic exercise combined with Levocarnitine on improving endothelial function and antioxidation in patients with stable angina pectoris of coronary heart disease / 中国综合临床

Objective To investigate the effect of aerobic exercise combined with Levocarnitine in treating stable angina pectoris ( SAP ) and its effect on vascular endothelial function and serum levels of superoxide dismutase ( SOD ), total antioxidant capacity ( TAC ), glutathione peroxidase ( GSH-px ), malondialdehyde (MDA),and lipid peroxide( LPO) . Methods One hundred and fifty patients with SAP were selected in Affiliated Hospital of Yan′an University from september 2017 to september 2018 and randomly divided into control group and observation group( 75 cases in each group) . Both groups received routine intervention according to the guidelines. The control group was given with intravenous drip of left carnitine(3 g／time and once a day). On basis of the control group,the observation group was treated with regular aerobic exercise therapy. After 8 weeks＇ treatment for two groups,attack frequency degree of angina pectoris,score of life quality of Seattle angina scale(SAQ),and clinical effect were compared between the two groups. And the vascular endothelial function ( plasma endothelin ( ET ) 1, nitric oxide ( NO )), flow mediated vasodilation(FMD) of brachial artery and antioxidant effect(serum levels of SOD,TAC,GSH-px, MDA and LPO) were detected. Results After 8 weeks＇treatment,frequency of angina pectoris and episode of duration of angina pectoris in the observation group were less(( 4. 19± 0. 56) vs. ( 6. 22 ± 0. 89) time, (4. 31±0. 50) vs. (5. 25±0. 71) min),while life quality indexes SAQ score was higher,than those in the control group,and the difference was statistically significant (( 18. 44 ± 2. 30) vs. ( 12. 49 ± 1. 82) score, (56. 31±6. 62) vs. (48. 05± 5. 88) score,(14. 46 ± 1. 99) vs. ( 9. 22 ± 1. 10) score,( 21. 41 ± 2. 95)) vs. (18. 09±2. 26) score,(16. 14±2. 17) vs. (12. 05±1. 82) score,(all P＜0. 01)). The total clinical effective rate of the observation group ( 92%( 69 ／ 75)) was higher than that of the control group ( 80%( 60 ／75)),the difference was statistically significant (χ2＝4. 485,P＝0. 034). After 8 weeks′ treatment,level of ET-1,FMD of brachial artery,MDA,and LPO were lower than those in the control group(( 65. 38± 7. 91) ng／L vs. (77. 12±8. 56) ng／L,( 9. 44± 1. 34)% vs. ( 12. 55± 1. 81)%,(2. 81± 0. 43) μmol／L vs. ( 3. 90 ±0. 50) μmol／L,(3. 14±0. 44) μmol／L vs. (4. 40± 0. 63) μmol／L),while NO,SOD,TAC,GSH-px were higher than control group(( 67. 51 ± 7. 79) μmol／L vs. ( 52. 17± 6. 08) μmol／L,( 85. 25± 9. 67) U／L vs. (76. 01±8. 33) U／L,(12. 79±1. 80) kU／L vs. (9. 64±11. 05) kU／L,(117. 65±15. 03) U／L vs. (111. 76 ±14. 19) U／L),and the difference was statistically significant (all P＜0. 01). Conclusion Aerobic exercise combined with Levocarnitine in treating SAP can reduce the attack of angina pectoris, improve the life treatment of patients,and improve the clinical effect,which may be related to the improvement of endothelial function and antioxidant effect.

Detection of colorectal polyps and adenomas in asymptomatic health examination population and analysis of relevant clinical factors / 国际外科学杂志

Objective@#To analysis the incidence and relevant clinical factors of colorectal polyps and adenomas in population of health examination.@*Methods@#Colonoscopy results and clinical data of 615 cases undergoing health examination from January 2018 to March 2019 were analyzed retrospectively in International Medical Center, Beijing Friendship Hospital, Capital Medical University.There were 436 males and 179 females, average age 47.38 years, aged 18-81 years. The clinical data contained sex, age, smoking history, drinking history, body mass index.Chi-square test and trend chi-square test were used to compare the differences of polyp detection rate and adenoma detection rate in different populations. Multivariate Logistic regression analysis were applied to explore the potential factors associated with the polyp detection rate and adenoma detection rate.@*Results@#Two hundred and forty cases(39.02%) with colorectal disease were checked out, include 206 cases(33.50%) with colorectal polyps and 138 cases(22.44%) with colorectal adenomas. In the detection rate of colorectal polyps, male were higher than female[36.70%(160/436) vs 25.70%(46/179), χ2=6.89, P<0.05], smokers were higher than non-smokers[42.35%(108/255) vs 27.22%(98/360), χ2=15.34, P<0.001], and drinkers were higher than non-drinkers[40.67%(109/268) vs 27.95%(97/347), χ2=10.98, P<0.05]. With the increase of age, the detection rate of colorectal polyps increased significantly(χ2=24.19, P<0.001). With the increase of body mass index, the detection rate of colorectal polyps increased significantly(χ2=16.88, P<0.001). In the detection rate of colorectal adenoma, smokers were higher than non-smokers[28.24%(72/255) vs 18.33%(66/360), χ2=7.31, P<0.05], and drinkers were higher than non-drinkers[27.61(74/268)% vs 18.44%(64/347), χ2=7.30, P<0.05]. With the increase of age, the detection rate of colorectal adenoma increased significantly(χ2=15.87, P<0.001). With the increase of body mass index, the detection rate of colorectal adenoma increased significantly (χ2=13.30, P<0.001). There was no significant difference in the detection rate of colorectal adenomas between male and female[24.31%(106/436) vs 17.88%(32/179), χ2=3.02, P>0.05]. Multivariate Logistic regression analysis showed that age increasing, body mass index increasing, smoking and alcohol consumption were risk factors for colorectal polyps and adenomas.@*Conclusions@#The detection rate of colorectal polyps and adenomas are related with sex, age, smoking, drinking and body mass index. Age increasing, body mass index increasing and smoking are the risk factors for colorectal polyps, age increasing and body mass index increasing are the risk factors for colorectal adenomas.

Correlation between 24-h ambulatory blood pressure variability and cerebral microbleeds in patients with ischemic stroke / 国际脑血管病杂志

Objective To investigate the correlation between 24-h ambulatory blood pressure (BP) variability and cerebral microbleeds (CMBs) in patients with acute ischemic stroke. Methods Consecutive inpatients with acute ischemic stroke were prospectively enrolled. 24-h ambulatory BP was monitored. Magnetic susceptibility-weighted imaging was used to evaluate CMBs and their locations. Univariate analysis was used to compare the baseline data between the CMBs group and the non-CMBs group. Multivariate logistic regression analysis was used to determine the independent correlation between ambulatory BP related indexes and CMBs. Results A total of 178 patients with acute ischemic stroke were enrolled, including 114 males, aged 67.6 ±10.8 years, and 90 (50.6%) with CMBs. The proportion of hypertension and asymptomatic lacunar infarction, periventricular and deep white matter high signal score, 24-h, daytime, nighttime mean systolic and diastolic BP, 24-h, and daytime systolic BP variability in the CMBs group were significantly higher than those in the non-CMB group (all P<0.05). Multivariate logistic regression analysis showed that 24-h systolic BP variability (odds ratio 1.133, 95% confidence interval 1.023-1.255; P=0.016) and daytime mean systolic BP (odds ratio 1.045, 95% confidence interval 1.022-1.069; P<0.001) had significant independent correlation with CMBs. Conclusion 24-h systolic BP variability and daytime mean systolic BP were the independent risk factors for CMBs in patients with acute ischemic stroke.

Clinical diagnosis and treatment of five cases with malignant tumors associated with Peutz-Jeghers syndrome / 国际外科学杂志

Objective To explore clinical characteristics,diagnosis and treatment method after Peutz-Jeghers Syndrome (PJS) secondary malignant.Methods The clinical date of five cases with malignant tumors associated with Peutz-Jeghers syndrome from June 2014 to January 2017 were analyzed retrospectively in Beijing Friendship Hospital,Capital Medical University.The patients were followed up by phone,outpatient service,and hospitalization.The starting point of the follow-up was the visit date.The patient's death was the end point.The clinical and pathological features,therapy,and postoperative survival were observed.The follow-up deadline was May 2018.Results PJS secondary malignant patients lack clinical specificity.Two cases of five patients accepted endoscopic resection,three cases accepted surgery,and were treated with chemotherapy postoperatively,including 1 case died from tumor progression of 6 months after operation.Tumor recurrence was not found in the rest 4 cases till May 2018.Conclusions Part of the malignant polyp,endoscopic resection is feasible.When endoscopic resection is not feasible,operation treatment is needed;and postoperative adjuvant chemotherapy is needed to improve the long-term prognosis.

A study on common bile duct primary suture after laparoscopic choledocholithotomy with bile duct decompression tube / 中华普通外科杂志

Objective To evaluate intraoperative placement of bile duct decompression drainage tube in CBD primary suture after laparoscopic choledocholithotomy.Methods 152 patients undergoing laparoscopic choledocholithotomy were divided into group A (placement of bile duct decompression drainage tube during operation,82 cases) and group B (no decompression drainage tube placement,70 casas).Results There was no significant difference in operative time and intraoperative bleeding between the two groups (P ＞ 0.05).In group B patients the abdominal drainage tube indwelling time,abdominal drainage volume,peritoneal drainage fluid bilirubin value,postoperative hospitalization time were significantly longer than group A,the difference was statistically significant (P ＜ 0.05).No recurrence of choledocholithiasis and biliary stricture were found in either groups.Conclusions Placement of bile duct decompression drainage tube in laparoscopic choledocholithotomy and CBD primary suture after laparoscopic choledochotomy can significantly reduce the incidence of biliary leakage and shorten the postoperative hospital stay.

Individualized Antiplatelet Therapy Analysis and Pharmaceutical Care for a Patient with Subacute Stent Thrombosis after PCI / 中国药房

OBJECTIVE:To investigate the role of clinical pharmacists in individualized antiplatelet therapy for a patient with subacute stent thrombosis after PCI.METHODS:Clinical pharmacists participated in the therapy for a myocardial infarction patient with diabetes,and the patient suffered from subacute stent thrombosis at the fourth day after PCI.Clinical pharmacists suggested performing clopidogrel-related gene detection [Cytochrome P450(CYP)2C19] through comprehensively analyzing the complexity of the lesion,the time of stent thrombosis,the number of stent implantations and combined diseases,etc.According to detection result (CYP2C19* 1/*2),clinical pharmacists suggested to additionally use Cilostazol tablets 50 mg,po,bid,on the basis of previous dual antiplatelet therapy;additionally use Alprostadil injection 10 μg,ivgtt,qd to improve microcirculation.Pharmaceutical care as therapeutic evaluation,ADR monitoring were performed,and medication education as medication notes and dietary adjustments were also provided.RESULTS:Physicians adopted the suggestions of clinical pharmacists;the patient was recovered and discharged from hospital.After discharge,the disease condition kept stable due to persistent aspirin+clopidogrel+cilostazol triple antiplatelet therapy.CONCLUSIONS:Drug metabolizing enzyme is an important cause of individual differences in antiplatelet effects and toxicity,and its gene polymorphism is closely related with clinical outcome and terminal event.Clinical pharmacists should play professional skill to assist physician to access and interpret relevant information,and formulate and adjust individualized antiplatelet therapy after considering disease condition,combined diseases and genotypes,so as to guarantee safe and effective drug use.

Ipragliflozin in the treatment of type 2 diabetes:a Meta analysis / 重庆医学

Objective To evaluate the efficacy and safety of different doses of Ipragliflozin in the treatment of type 2 diabetes patients.Methods The randomized controlled trials (RCTs) about Ipragliflozin in treatment of type 2 diabetes patients were retrieved from the databases,including Cochrane Library,PubMed,Embase,Medline,CNKI,Wangfang,VIP and CBM.The data were extracted and evaluated by two researchers independently,and the Meta-analysis was performed via RevMan5.2.Results A total of 10 RCTs involving 1 928 patients were included.The results of Meta-analysis showed that glycosylated hemoglobin (HbA1c)[12.5 mg/d:MD=-0.46,95％CI (-0.69,-0.23);25 mg/d:MD=-0.97,95％CI (-1.00,-0.94);50 mg/d:MD=-0.94,95％CI (-1.20,-0.69);100 mg/d:MD=-0.93,95％CI (-1.72,-0.15);150 mg/d:MD=-0.57,95％CI (-0.89,-0.26);200 mg/d:MD=-0.74,95％CI (-1.14,-0.34);300 mg/d:MD=-0.64,95％CI (-0.86,-0.43)],fasting blood glucose (FPG) [12.5 mg/d:MD=-1.52,95％CI(-1.58,-1.47);25 mg/d:MD=-1.98,95％CI (-2.04,-1.93);50 mg/d:MD=-2.53,95％CI(-2.59,-2.48);100 mg/d:MD=-3.27,95％CI(-3.32,-3.21);150 mg/d:MD=-1.29,95％CI (-1.90,-0.68);200 mg/d:MD=-3.34,95％CI (-4.78,-1.90);300 mg/d:MD=-1.73,95％CI(-2.28,-1.18)] and body weight [12.5mg/d:MD=-0.92,95％CI(-1.36,-0.47);25 mg/d:MD=-1.30,95％CI (-1.81,-0.79);50 mg/d:MD=-1.58,95％CI (-1.80,-1.35);100 mg/d:MD=-1.31,95％CI(-1.65,-0.97);150 mg/d:MD=-1.51,95％CI (-2.42,-0.60);300 mg/d:MD=-1.73,95％ CI (-2.63,-0.83)] were significantly reduced in the different doses of Ipragliflozin group than that in the placebo group,and the dose of 50 mg/d and 100 mg/d were better.There was no significant difference in the incidence rate of the overall adverse reaction,hypoglycemic events,urinary tract infection and genital infection between the different doses of Ipragliflozin group and the placebo group (P＞0.05),but data showed that dose of 50 mg/d was more security than 100 mg/d (RR:1.02 vs.2.18,1.83 vs.2.88,1.01 vs.1.72,1.85 vs.2.98).Conclusion Ipragliflozin is effective and safe for the patients with type 2 diabetes,which could effectively control the patients' HbA1c,FPG and body weight,and 50 mg/d may be the best dose.

Ipragliflozin in the treatment of type 2 diabetes:a Meta analysis / 重庆医学

Objective To evaluate the efficacy and safety of different doses of Ipragliflozin in the treatment of type 2 diabetes patients.Methods The randomized controlled trials (RCTs) about Ipragliflozin in treatment of type 2 diabetes patients were retrieved from the databases,including Cochrane Library,PubMed,Embase,Medline,CNKI,Wangfang,VIP and CBM.The data were extracted and evaluated by two researchers independently,and the Meta-analysis was performed via RevMan5.2.Results A total of 10 RCTs involving 1 928 patients were included.The results of Meta-analysis showed that glycosylated hemoglobin (HbA1c)[12.5 mg/d:MD=-0.46,95％CI (-0.69,-0.23);25 mg/d:MD=-0.97,95％CI (-1.00,-0.94);50 mg/d:MD=-0.94,95％CI (-1.20,-0.69);100 mg/d:MD=-0.93,95％CI (-1.72,-0.15);150 mg/d:MD=-0.57,95％CI (-0.89,-0.26);200 mg/d:MD=-0.74,95％CI (-1.14,-0.34);300 mg/d:MD=-0.64,95％CI (-0.86,-0.43)],fasting blood glucose (FPG) [12.5 mg/d:MD=-1.52,95％CI(-1.58,-1.47);25 mg/d:MD=-1.98,95％CI (-2.04,-1.93);50 mg/d:MD=-2.53,95％CI(-2.59,-2.48);100 mg/d:MD=-3.27,95％CI(-3.32,-3.21);150 mg/d:MD=-1.29,95％CI (-1.90,-0.68);200 mg/d:MD=-3.34,95％CI (-4.78,-1.90);300 mg/d:MD=-1.73,95％CI(-2.28,-1.18)] and body weight [12.5mg/d:MD=-0.92,95％CI(-1.36,-0.47);25 mg/d:MD=-1.30,95％CI (-1.81,-0.79);50 mg/d:MD=-1.58,95％CI (-1.80,-1.35);100 mg/d:MD=-1.31,95％CI(-1.65,-0.97);150 mg/d:MD=-1.51,95％CI (-2.42,-0.60);300 mg/d:MD=-1.73,95％ CI (-2.63,-0.83)] were significantly reduced in the different doses of Ipragliflozin group than that in the placebo group,and the dose of 50 mg/d and 100 mg/d were better.There was no significant difference in the incidence rate of the overall adverse reaction,hypoglycemic events,urinary tract infection and genital infection between the different doses of Ipragliflozin group and the placebo group (P＞0.05),but data showed that dose of 50 mg/d was more security than 100 mg/d (RR:1.02 vs.2.18,1.83 vs.2.88,1.01 vs.1.72,1.85 vs.2.98).Conclusion Ipragliflozin is effective and safe for the patients with type 2 diabetes,which could effectively control the patients' HbA1c,FPG and body weight,and 50 mg/d may be the best dose.