Clinical application of modified pancreaticogastrostomy based on the concept of " Hong's one-stitch method" in digestive tract reconstruction in pancreaticoduodenectomy / 中华肝胆外科杂志

Objective:To study the safety and therapeutic effects of the modified pancreaticogastrostomy based on the concept of " Hong's one-stitch method" in digestive tract reconstruction in pancreatic surgery.Methods:The clinical data of 44 patients who underwent modified pancreaticogastresstomy at the Department of Hepatobiliary Surgery, the Second Hospital of Hebei Medical University from May 2022 to October 2022 were analyzed retrospectively. There were 23 males and 21 females , with a median age of 54 years old (range 18 to 70 years old). The operation time, intraoperative blood loss, postoperative condition and complications were analysed.Results:All the 44 patients completed the operation successfully. There were 29 patients who underwent laparoscopic pancreaticoduodenectomy, 11 patients laparoscopic duodenum-preserving pancreatic head resection, 1 patient laparoscopic central pancreatectomy, and 3 patients open pancreaticoduodenectomy. The time required for the pancreaticogastrostomy was (15.4±1.0) min in laparoscopic surgery, and (9.1±0.5) min in open surgery. There were 2 patients who developed grade A pancreatic fistula (4.55%, 2/44) and 7 patients gastric emptying disorder (15.91%, 7/44). There were no grade B or C pancreatic fistula, biliary fistula, gastrointestinal anastomotic fistula, abdominal infection, postoperative bleeding and perioperative death.Conclusion:The modified pancreaticogastrostomy for digestive tract reconstruction in pancreatic surgery was safe and reliable. It effectively reduced the incidence of postoperative pancreatic fistula and improved prognosis of patients.

Effect of intra-operative chemotherapy with 5-fluorouracil and leucovorin on the survival of patients with colorectal cancer after radical surgery: a retrospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#The effect of intra-operative chemotherapy (IOC) on the long-term survival of patients with colorectal cancer (CRC) remains unclear. In this study, we evaluated the independent effect of intra-operative infusion of 5-fluorouracil in combination with calcium folinate on the survival of CRC patients following radical resection.@*METHODS@#1820 patients were recruited, and 1263 received IOC and 557 did not. Clinical and demographic data were collected, including overall survival (OS), clinicopathological features, and treatment strategies. Risk factors for IOC-related deaths were identified using multivariate Cox proportional hazards models. A regression model was developed to analyze the independent effects of IOC.@*RESULTS@#Proportional hazard regression analysis showed that IOC (hazard ratio [HR]=0.53, 95% confidence intervals [CI] [0.43, 0.65], P  < 0.001) was a protective factor for the survival of patients. The mean overall survival time in IOC group was 82.50 (95% CI [80.52, 84.49]) months, and 71.21 (95% CI [67.92, 74.50]) months in non-IOC group. The OS in IOC-treated patients were significantly higher than non-IOC-treated patients ( P  < 0.001, log-rank test). Further analysis revealed that IOC decreased the risk of death in patients with CRC in a non-adjusted model (HR=0.53, 95% CI [0.43, 0.65], P  < 0.001), model 2 (adjusted for age and gender, HR=0.52, 95% CI [0.43, 0.64], P  < 0.001), and model 3 (adjusted for all factors, 95% CI 0.71 [0.55, 0.90], P  = 0.006). The subgroup analysis showed that the HR for the effect of IOC on survival was lower in patients with stage II (HR = 0.46, 95% CI [0.31, 0.67]) or III disease (HR=0.59, 95% CI [0.45, 0.76]), regardless of pre-operative radiotherapy (HR=0.55, 95% CI [0.45, 0.68]) or pre-operative chemotherapy (HR=0.54, 95% CI [0.44, 0.66]).@*CONCLUSIONS@#IOC is an independent factor that influences the survival of CRC patients. It improved the OS of patients with stages II and III CRC after radical surgery.@*TRIAL REGISTRATION@#chictr.org.cn, ChiCTR 2100043775.

Difficulties and strategies of total mesorectal excision for middle and low rectal cancer after neoadjuvant therapy / 中华消化外科杂志

Patients with local advanced rectal cancer (LARC) can benefit from neoadju-vant chemoradiotherapy (nCRT) of reducing local recurrence rate and improving survival rate. However, tissue edema after nCRT may lead to unclear tissue spaces, making it challenging for lymph node dissection and nervous system protection. The difficulty in locating inferior margin of tumor after clinical complete remission or closing to clinical complete remission, as well as the increasing risk of anastomotic leakage after nCRT, pose difficulties and new challenges of total mesorectal excision for middle and low rectal cancer. Based on literatures and clinical experiences, the authors summarize the difficulties and strategies of total mesorectal excision after nCRT, in order to provide reference for colleagues.

Effect of pre-infusion of young rat plasma on cognitive dysfunction induced by sevoflurane in aged rats and role of ERK-CREB signaling pathway / 中华麻醉学杂志

Objective:To evaluate the effect of pre-infusion of young rat plasma on cognitive dysfunction induced by sevoflurane in aged rats and the role of extracellular regulated protein kinase (ERK)-cyclic adenosine monophosphate effector binding protein (CREB) signaling pathway.Methods:One hundred and twenty SPF healthy male Wistar rats, aged 18 months, weighing 550-650 g, were divided into 4 groups ( n=30 each) using a random number table method: control group (group C), sevoflurane anesthesia group (group S), young rat plasma group (group P) and ERK inhibitor SL327 group (group SL). The teated plasma 100 μl from 3-month-old young rats was injected via the tail vein in group P and group SL, while the equal volume of normal saline was given via the tail vein in group C and group S, twice a week, for 4 weeks.In S, P and SL groups, 3% sevoflurane was inhaled for 3 h at the end of injection, and ERK inhibitor SL327 50 mg/kg was injected via the tail vein before anesthesia in group SL.The cognitive function was evaluated by Morris water maze test at 1 day before anesthesia and at 3 and 7 days after anesthesia.The rats were sacrificed, and their hippocampi were isolated for determination of the expression of phosphorylated ERK (p-ERK), p-CREB, synapsin, synapsin Ⅰ and synaptophysin and for examination of the ultrastructure of neurons (by transmission electron microscopy). The number of synapses was recorded. Results:Compared with group C, the escape latency was significantly prolonged, the number of crossing the original platform was reduced, the expression of p-ERK, p-CREB, synapsin, synapsin Ⅰ and synaptophysin was down-regulated, and the number of synapses was decreased at each time point after anesthesia in the other 3 groups ( P<0.05). Compared with group S, the escape latency was significantly shortened, the number of crossing the original platform was increased, the expression of p-ERK, p-CREB, synapsin, synapsin Ⅰ and synaptophysin was up-regulated, and the number of synapses was increased at each time point after anesthesia in P and SL groups ( P<0.05). Compared with group P, the escape latency was significantly prolonged, the number of crossing the original platform was reduced, the expression of p-ERK, p-CREB, synapsin, synapsin Ⅰ and synaptophysin was down-regulated, and the number of synapses was decreased in group SL ( P<0.05). Conclusion:Pre-infusion of young rat plasma can reduce cognitive dysfunction induced by sevoflurane in aged rats, and the mechanism is related to activation of ERK-CREB signaling pathway and improvement of synaptic plasticity.

Treatment strategy of gastrointestinal stromal tumors in the background of COVID-19 / 中华胃肠外科杂志

COVID-19, caused by SARS-COV-2, has the characteristics of world epidemic, highly infectious and large base of death. In China, transmission route of SARS-COV-2 has been contained so effectively that COVID-19 has been well controlled due to the proactive national prevention and control strategy. However, not only does it bring a huge impact on the existing medical structure model, but also an objective impact on the treatment of patients with chronic diseases such as malignant tumors. Based on the progress reported in the domestic and international literatures and the actual management experience of our team, this paper reflects on the treatment strategies for patients with gastrointestinal stromal tumor (GIST) during the epidemic period of COVID-19. We focus on risk stratification for primary GIST and forming treatment strategies accordingly. Major considerations include the impact of delayed operation, the burden of medical resources, the waiting time for elective operation, and the principle of emergency operation. In addition, we focus on the level of evidence for non-surgical approaches with a view to developing a holistic strategy of "priority management principles" to guide clinical treatment in the context of limited resources and different GIST priorities.

Thinking of treatment strategies for colorectal cancer patients in tumor hospitals under the background of coronavirus pneumonia / 中华胃肠外科杂志

In December 2019, a new outbreak of coronavirus pneumonia began to occur. Its pathogen is 2019-nCoV, which has the characteristics of strong infectivity and general susceptibility. The current situation of prevention and control of new coronavirus pneumonia is severe. In this context, as front-line medical workers bearing important responsibilities and pressure, while through strict management strategy, we can minimize the risk of infection exposure. By summarizing the research progress and guidelines in recent years in the fields of colorectal cancer disease screening, treatment strategies(including early colorectal cancer, locally advanced colorectal cancer, obstructive colorectal cancer, metastatic colorectal cancer and the treatment of patients after neoadjuvant therapy), the choice of medication and time limit for adjuvant therapy, the protective measures for patients undergoing emergency surgery, the re-examination of postoperative patients and the protection of medical staff, etc., authors improve treatment strategies in order to provide more choices for patients to obtain the best treatment under the severe epidemic situation of new coronavirus pneumonia. Meanwhile we hope that it can also provide more timely treatment modeling schemes for colleagues.

Effect of lymph node dissection on recovery and prognosis in rectal cancer patients in different stages treated with radical resection / 中华老年医学杂志

Objective:To investigate the effect of 253 lymph node dissection on postoperative recovery and prognosis of rectal cancer patients in different stages undergoing radical resection.Methods:A total of 232 rectal cancer patients undergoing radical resection in the Fourth Hospital of Hebei Medical University between January 2013 and December 2014 were enrolled and divided into the 253 lymph node dissection group(all cases underwent surgery in 2014)and the non-dissection group(all cases underwent surgery in 2013). Differences in age, sex, tumor differentiation and depth of invasion was analyzed between the two groups.Based on clinicopathological data, each group was further divided into three subgroups(Ⅰ, Ⅱ, Ⅲ). Postoperative recovery assessment included the time of the earliest flatulence, the time of first feeding, the duration of hospitalization and anastomotic leakage.In addition, postoperative survival parameters were also analyzed.Results:Compared with non-dissection group, patients in the 253 lymph node dissection group had similar overall postoperative recovery and rates of complications( P>0.05), but significantly longer survival( P=0.012). Besides, 253 lymph node dissection had a beneficial effect on prognosis for those in the stage Ⅲ subgroup( P=0.039), and did not affect the prognosis for those in the stage Ⅰ and Ⅱ subgroups( P>0.05). Conclusions:For rectal cancer patients undergoing radical resection, 253 lymph node dissection does not affect postoperative recovery, but offers improved prognosis for stage Ⅲ patients.We should perform 253 lymph node dissections on all rectal cancer patients when the clinicopathological staging is unknown.

Relationship between visceral fat area and brachial-ankle pulse wave velocity in patients with diabetic nephropathy / 中国基层医药

Objective:To investigate the clinical characteristics of different stages of type 2 diabetic nephropathy(DN), and to explore the possible factors affecting visceral fat area (VFA).Methods:From September 2018 to March 2019, 464 patients with type 2 diabetes who were hospitalized in the First Affiliated Hospital of Datong University were selected.Among them, 315 patients with urinary albumin/creatinine ratio(UACR)<30 mg/g were selected as normal proteinuria group, 72 patients with UACR 30-299 mg/g were selected as microalbuminuria group, 45 patients with UACR>300 mg/g were selected as massive proteinuria group, and 32 patients with serum creatinine higher than the reference value were selected as renal failure group.The serum creatinine of the first three groups was in the normal range.The clinical data of these patients such as blood pressure, body mass index(BMI), VFA, subcutaneous fat area(SFA), brachial-ankle pulse wave velocity(BAPWV), blood lipid, renal function and blood sugar were collected and compared among the four groups.Using VFA as strain and other indicators as independent variables, multivariate linear regression analysis was carried out.Results:There were statistically significant differences among the four groups in age, height, weight, BMI, head circumference, neck circumference, waist circumference, hip circumference and waist-hip ratio ( F=15.580, 4.679, 6.186, 3.553, 3.153, 2.689, 5.170, 3.114, 3.535, all P<0.05). The VFA of the normal proteinuria group, microalbuminuria group, massive proteinuria group and renal failure group were (102.25±37.09)cm 2, (104.12±40.93)cm 2, (119.63±48.82)cm 2, (110.54±41.58)cm 2, respectively, and the BAPWV were (1 546.97±330.18)cm/s, (1 595.52 ±381.27)cm/s, (1 459.63±285.61)cm/s, (1 703.89±318.64)cm/s, the differences were statistically significant among the four groups( F=3.344, 4.020, all P<0.05). There were statistically significant differences in alanine aminotransferase, creatinine, uric acid, total cholesterol, red blood cell, hemoglobin, ratio of neutrophils to lymphocytes (NLR) and ratio of platelets to lymphocytes (PLR) among the four groups ( F=3.405, 15.535, 6.552, 2.803, 6.158, 15.580, 3.764, 3.262, all P<0.05). With VFA as strain, multivariate linear regression analysis showed that waist circumference, BMI, TG and BAPWV were risk factors for VFA. Conclusion:DN is associated with multiple obesity-related indicators and inflammatory indicators such as NLR, PLR; VFA is associated with BAPWV.

Study on the relationship between procalcitonin level and insulin resistance in patients with diabetic foot infection / 中国基层医药

Objective:To investigate the relationship between procalcitonin(PCT) and insulin resistance in diabetic foot infection.Methods:Sixty patients with diabetic foot infection hospitalized in the Fifth People's Hospital of Datong from March 2015 to March 2017 were selected and divided into three groups according to the value of PCT: slightly elevated group(L group, n=18), moderately elevated group(M group, n=21), highly elevated group(H group, n=21). Another 20 patients with type 2 diabetes mellitus were collected as control group.The PCT, C-reactive protein(CRP), white blood cell count(WBC), fasting and postprandial blood glucose, fasting insulin and insulin resistance index(HOMA-IR) were calculated and compared. Results:In the control group, the levels of PCT, HOMA-IR, CRP and WBC were (0.14±0.12)μg/L, (17.70±8.86), (32.90±24.19)mg/L, (8.01±2.21)×10 9/L, respectively, which in the L group were (0.31±0.14)μg/L, (20.42±9.71), (50.85±27.81)mg/L, (9.95±3.35)×10 9/L, respectively, which in the M group were (1.11±0.52)μg/L, (24.08±14.09), (64.31±40.21)mg/L, (10.86±2.25)×10 9/L, respectively, which in the H group were (5.31±3.04)μg/L, (31.73±14.13), (72.29±50.26)mg/L, (12.51±5.51)×10 9/L, respectively, and there were statistically significant differences among the four groups( F=50.744, 5.195, 4.303, 5.252, all P<0.01). With the increase of PCT, the levels of WBC, CRP and HOMA-IR were increased, and HOMA-IR was positively correlated with PCT( r=0.265, P=0.017). Conclusion:Serum level of PCT has correlation with infection degree of diabetic foot and is positively correlated with insulin resistance.

Clinical effect of fasudil combined with cattle encephalon glycoside and ignotin injection in the treatment of diabetic deafness and tinnitus / 中国基层医药

Objective@#To study the clinical effect of fasudil plus cattle encephalon glycoside and ignotin injection in treating diabetic deafness and tinnitus.@*Methods@#From January 2016 to December 2016, 60 patients with diabetic deafness and tinnitus in the Fifth People's Hospital of Datong were selected and randomly divided into two groups according to the digital table, with 30 cases in each group.The treatment group received fasudil injection plus cattle encephalon glycoside and ignotin injection (iv gtt), and the control group received cattle encephalon glycoside and ignotin injection.The effective rate after treatment for 10 days and 20 days were compared between the two groups.@*Results@#Compared with the control group, the effective rate of hearing in the treatment group was not higher at 10 days after treatment (26.7% vs.16.7%, χ2=0.884, P=0.347), while it was higher in the treatment group at 20 days after treatment (53.3% vs.26.7%, χ2=4.444, P=0.035). The effective rate of tinnitus in the treatment group at 10 days after treatment was not higher compared with the control group (30.0% vs.20.0%, χ2=1.491, P=0.222), while it was higher in the treatment group at 20 days after treatment (56.7% vs.30.0%, χ2=4.344, P=0.037). As far as hearing threshold: there were no statistically significant differences between the control group and the observation group before treatment and 10 days after treatment(all P>0.05). The hearing threshold of the observation group was significantly better than that of the control group at 20 days after treatment (t=-2.511, P=0.02).@*Conclusion@#The combination therapy of fasudil injection plus cattle encephalon glycoside and ignotin injection has better efficacy for diabetic deafness and tinnitus.

Clinical effect of anisodamine combined with gabapentin on painful diabetic neuropathy / 中国基层医药

Objective@#To assess the clinical effect of anisodamine combined with gabapentin on painful diabetic neuropathy(PDN).@*Methods@#From June 2013 to February 2017, 120 patients with PDN in the Fifth People's Hospital of Datong were assigned into anisodamine group, gabapentin group and combined group according to the digital table, with 40 cases in each group, the patients were treated with anisodamine, gabapentin and combination therapy respectively.The abnormal foot plantar pressure, MCV and SCV of median nerve and common peroneus nerve, VAS and total effective rate of three groups were compared.@*Results@#After treatment, the indicators of the combined group were improved more significantly than those of the anisodamine group and gabapentin group in abnormal foot plantar pressure[(6.10±1.66) vs.(10.80±2.64) vs.(6.37±1.44), F=14.602, P<0.01], total effective rate (92.5% vs.62.2% vs.75.0%, χ2=10.155, P=0.006), MCV[(50.33±5.54)m/s vs.(41.12±4.47)m/s vs.(42.32±4.40)m/s, F=9.404, P=0.001], and SCV of median nerve[(48.51±6.19)m/s vs.(41.81±5.72)m/s vs.(41.76±7.17)m/s, F=3.728, P=0.037], MCV of common peroneus nerve[(40.60±5.69)m/s vs.(32.04±4.47)m/s vs.(33.52±7.76)m/s, F=5.614, P=0.009]and SCV of common peroneus nerve[(42.72±4.97)m/s vs.(36.21±6.16)m/s vs.(35.45±5.54)m/s, F=4.265, P=0.025]. After treatment, the VAS scores of the three groups decreased, which were (4.49±1.61)points, (5.82±1.58)points, (6.37±1.44)points, respectively, the difference was statistically significant(F=14.602, P=0.000), and the decrease was more significant in the combined group.@*Conclusion@#Compared with the anisodamine group and gabapentin group, the combined treatment is more effective on PDN.

The status analysis of diagnosis and treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China: a report of 1 003 cases in 16 domestic medical centers / 中华外科杂志

Objective@#To analyze the status of domestic surgical treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China.@*Methods@#Clinicopathological data of patients who underwent surgery from October 2003 to October 2018 in 16 domestic medical centers was retrospectively analyzed. Excel database was created which covered 77 fields of 7 parts: baseline information of patients, laboratory tests, imaging tests, chemoradiotherapy information, intra-operative findings, postoperative pathology and follow-up data. The Wilcoxon rank-sum test was used for comparison of the measurement data between groups. The χ2 test was used for comparison of the categorical data between groups. The survival curve was calculated by the Kaplan-Meier method.@*Results@#Of the 1 003 patients, there were 575 male and 428 female patients with the age of (58.5±14.1) years (range: 18 to 92 years). In a total of 920 patients, the carcinoma of sigmoid colon was performed in 292 cases (31.8%) with the highest ratio. The proportion of patients with liver metastasis and lung metastasis were 27.9% (219/784) and 8.3% (64/769). Preoperative detection of carcino-embryonic antigen level was the most common method in China (87.74%, 880/1 003), and the positive rate was 64.5% (568/880). The correct rate of preoperative imaging tests was 40.7% (280/688). The ratio of peritoneal carcinomatosis index (PCI) scores between 0 and 10 was the highest (59.6%, 170/285). Two hundred and sixty-two (27.0%) patients were performed by totally laparoscopic operation in 971 patients. The resection of primary tumor was performed in 588 of the 817 patients (72.0%). In a total of 457 cases, 253 (55.4%) patients were performed cytoreduction which group scored completeness of cytoreduction (CCR) 0. The postoperative hyperthermic intraperitoneal chemotherapy was implemented in 70 of the 334 cases (21.0%). Among 1 003 cases, 562 cases (56.03%) had complete follow-up data and the median overall survival was 15 months. The primary tumor resection and the CCR scores were affected by the PCI scores. The patients underwent primary tumor resection (187/205 vs. 26/80, χ2=105.085, P=0.000) and the patients were performed cytoreduction which scored CCR 0 or CCR 1 (162/204 vs. 8/78, Z=-10.465, P=0.000) had significant difference between the groups of PCI<20 and ≥20. There was a close correlation between the surgical method and the CCR scores (Z=-3.246,P=0.001).When the maximum degree of tumor reduction was planned, most surgeons would choose laparotomy. The overall survival time was longer in patients with primary tumor resection (P=0.000). The median survival time was 18.6 months in the group of primary tumor resection.@*Conclusions@#It is difficult to diagnose the synchronous peritoneal carcinomatosis from colorectal cancer before the operation. Primary tumor resection has an obvious effect to prolong the survival time. It is necessary to standardize the treatment of peritoneal metastasis.

Clinical effect of anisodamine combined with gabapentin on painful diabetic neuropathy / 中国基层医药

Objective To assess the clinical effect of anisodamine combined with gabapentin on painful diabetic neuropathy(PDN).Methods From June 2013 to February 2017,120 patients with PDN in the Fifth People's Hospital of Datong were assigned into anisodamine group,gabapentin group and combined group according to the digital table,with 40 cases in each group,the patients were treated with anisodamine,gabapentin and combination therapy respectively.The abnormal foot plantar pressure,MCV and SCV of median nerve and common peroneus nerve,VAS and total effective rate of three groups were compared.Results After treatment,the indicators of the combined group were improved more significantly than those of the anisodamine group and gabapentin group in abnormal foot plantar pressure[(6.10 ± 1.66) vs.(10.80 ± 2.64) vs.(6.37 ± 1.44),F =14.602,P ＜ 0.01],total effective rate (92.5％ vs.62.2％ vs.75.0％,x2 =10.155,P=0.006),MCV[(50.33 ±5.54)m/s vs.(41.12 ±4.47)m/s vs.(42.32 ±4.40)m/s,F=9.404,P =0.001],and SCV of median nerve[(48.51 ±6.19)m/s vs.(41.81 ±5.72)m/s vs.(41.76 ± 7.17) m/s,F =3.728,P =0.037],MCV of common peroneus nerve [(40.60 ± 5.69) m/s vs.(32.04 ± 4.47) m/s vs.(33.52 ± 7.76) m/s,F =5.614,P =0.009] and SCV of common peroneus nerve [(42.72 ± 4.97) m/s vs.(36.21 ± 6.16) m/s vs.(35.45 ± 5.54) m/s,F =4.265,P =0.025].After treatment,the VAS scores of the three groups decreased,which were (4.49 ± 1.61) points,(5.82 ± 1.58) points,(6.37 ± 1.44) points,respectively,the difference was statistically significant (F =14.602,P =0.000),and the decrease was more significant in the combined group.Conclusion Compared with the anisodamine group and gabapentin group,the combined treatment is more effective on PDN.

Clinical effect of fasudil combined with cattle encephalon glycoside and ignotin injection in the treatment of diabetic deafness and tinnitus / 中国基层医药

Objective To study the clinical effect of fasudil plus cattle encephalon glycoside and ignotin injection in treating diabetic deafness and tinnitus.Methods From January 2016 to December 2016,60 patients with diabetic deafness and tinnitus in the Fifth People＇s Hospital of Datong were selected and randomly divided into two groups according to the digital table ,with 30 cases in each group.The treatment group received fasudil injection plus cattle encephalon glycoside and ignotin injection (iv gtt),and the control group received cattle encephalon glycoside and ignotin injection.The effective rate after treatment for 10 days and 20 days were compared between the two groups.Results Compared with the control group ,the effective rate of hearing in the treatment group was not higher at 10 days after treatment (26.7%vs.16.7%,χ2 ＝0.884,P＝0.347),while it was higher in the treatment group at 20 days after treatment (53.3%vs.26.7%,χ2 ＝4.444,P＝0.035).The effective rate of tinnitus in the treatment group at 10 days after treatment was not higher compared with the control group (30.0%vs.20.0%,χ2 ＝1.491,P＝0.222),while it was higher in the treatment group at 20 days after treatment (56.7% vs.30.0%,χ2 ＝4.344,P＝0.037).As far as hearing threshold :there were no statistically significant differences between the control group and the observation group before treatment and 10 days after treatment ( all P ＞0.05).The hearing threshold of the observation group was significantly better than that of the control group at 20 days after treatment (t＝－2.511,P＝0.02 ).Conclusion The combination therapy of fasudil injection plus cattle encephalon glycoside and ignotin injection has better efficacy for diabetic deafness and tinnitus.

Impact of primary tumor site on the prognosis in different stage colorectal cancer patients after radical resection / 中华外科杂志

Objective@#To analyze the effect to the prognosis of tumor site on the patients of colorectal cancer after curative resection with different stage.@*Methods@#Clinicopathological and follow-up data of 2 097 colorectal carcinoma cases undergoing resection at Fourth Hospital of Hebei Medical University from January 2008 to March 2015 were retrospectively analyzed. There were 421 patients in left-sided colorectal cancer (LCC) group (including carcinoma in cecum, ascending colon , hepatic flexure, and transvers colon) , 386 in right-sided colorectal cancer (RCC) group (including carcinoma in splenic flexure, descending colon and sigmoid colon) and 1 290 in rectal cancer (RECC) group. Clinicopathologic features in patients with different tumor location were compared. 5-year overall survival rate were compared among the 3 groups. Patients were stratified by different stage to analyze the effect of tumor location on the prognosis. χ2test and Kruskal-Wallis rank-sum test were used to compare the clinicopathological features among the 3 groups, Kaplan-Meier curve and Log-rank test were used to analyze prognosis, respectively.@*Results@#No significant differences were identified between the three groups in age, family history, N stage and intestinal obstruction. Significant difference were found in gender among LCC, RCC and RECC group (male were 62.5% vs. 54.9% vs.56.3%, χ2=6.040, P=0.049) . Compared with LCC group and RCC group, RECC group had more well and moderately differentiated adenocarcinoma patients (89.7% vs. 86.0% vs. 82.4%, χ2=10.712 and 17.385, P=0.013 and 0.001) , more stage Ⅰ patients (17.1% vs. 6.9% vs. 6.5%, χ2=37.459 and 37.208, P=0.000 and 0.000) , and less likely to be stage T4 (44.7% vs. 76.7% vs.78.5%, χ2=128.015 and 133.704, P=0.000 and 0.000), metastasis (2.6% vs. 5.7% vs. 3.6%, χ2=1 417.167 and 1 424.217, P=0.000 and 0.000) and intestinal obstruction (11.3% vs. 21.1% vs. 24.4%, χ2=25.846 and 41.141, P=0.000 and 0.000). Five-year survival rate reduced in turn in the patients with RECC, LCC and RCC(70.9%, 59.8%, 58.9%, χ2=11.577, P=0.009). In the subgroup of stage Ⅲ, patients with different tumor location had different overall survival (χ2=9.878, P=0.007). Compared to right-sided colon cancer patients, rectal ones had significantly better overall survival (χ2=9.271, P=0.002); but in the subgroup of stage Ⅰ, Ⅱ and stage Ⅳ, patients with different tumor location had similar overall survival (P were 0.124, 0.888, 0.263, respectively).@*Conclusions@#Colorectal cancer patients with tumor location had different clinicopathologic features. Patients with rectal cancer had better five-year survival rate than those with left located and right located colon cancer. Tumor location had different effects on the prognosis according to the different TNM stage-subgroups.

Preliminary report on prospective, multicenter, open research of selective surgery after expandable stent combined with neoadjuvant chemotherapy in the treatment of obstructive left hemicolon cancer / 中华胃肠外科杂志

OBJECTIVE@#To evaluate the safety and feasibility of neoadjuvant chemotherapy prior elective surgery following self-expanding metallic stents (SEMS) for complete obstructive left hemicolon cancer.@*METHODS@#This prospective, multicenter, open-labelled trial was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University(2016-ke-161-1) and registered in Clinicaltrials.gov (NCT02972541).@*INCLUSION CRITERIA@#(1)age between 18 and 75 years old;(2) adenocarcinoma confirmed by pathology;(3) left hemicolon cancer confirmed by clinical manifestations and imaging examinations with the distance to anal verge > 15 cm; (4) resectable cancer evaluated by imaging examination without distant metastasis; (5) Eastern Cooperative Oncology Group (ECOG) score ≤ 1 or Karnofsky Performance Scale (KPS) > 70, indicating tolerance of neoadjuvant chemotherapy and operation; (6) absence of chemotherapy or radiotherapy within past six months; (7) bone marrow system and hepatorenal function: hemoglobin ≥ 90 g/L, neutrophil ≥ 1.5×10/L, platelet ≥ 80×10/L, total bilirubin ≤ 1.5×ULN(upper limits of normal), serum transaminase ≤ 2.5×ULN, serum creatinine ≤ 1.0×ULN, endogenous creatinine clearance rate > 50 ml/min; (8) sign for informed consent.@*EXCLUSION CRITERIA@#(1) multiple primary colorectal cancer; (2) rejection of operation;(3) presenting peritonitis or bowel perforation before SEMS; (4) unqualified conditions proved by inspector from registration data. According to inclusion criteria, 62 consecutive patients receiving neoadjuvant chemotherapy prior to elective surgery following SEMS for complete obstructive left hemicolon cancer from Beijing Chaoyang Hospital of Capital Medical University (n=31), Qilu Hospital of Shandong University (n=14), the Third Xiangya Hospital of Central South University (n=13), Zhongnan Hospital of Wuhan University (n=2), the Fourth Hospital of Hebei Medical University (n=2) between December 2015 and December 2017 were prospectively enrolled in this study. Patients were divided into neoadjuvant chemotherapy group and elective surgery group according to the investigator's clinical experience and patient's preference. Patients in the elective surgery group received surgery within one to two weeks after SEMS placement without neoadjuvant chemotherapy. Those in the neoadjuvant chemotherapy group received 2 cycles of CapeOX or 3 cycles of mFOLFOX6 neoadjuvant chemotherapy within one to two weeks after SEMS placement, and then underwent surgery within 3 weeks after finishing neoadjuvant chemotherapy. Data between groups were compared using Student t-test, chi-square analysis or Fisher exact test analysis, including basic clinical informations, operational conditions and postoperative complications. The adverse reactions during the neoadjuvant chemotherapy were recorded. Surgical difficulty was assessed using visual analog scales ranging from 1 to 10, where 1 represented the lowest and 10 the highest degree of surgical difficulty, as judged by the surgeon.@*RESULTS@#The study included 38 males and 24 females with mean age of (64.8±8.8) years. The clinical baseline data between 2 groups were not significantly different (all P>0.05) except the average time interval between SEMS and surgery was significantly longer in neoadjuvant chemotherapy group [(61.6±13.5) days vs. (10.4±5.2) days, t=16.679, P0.05).@*CONCLUSION@#Neoadjuvant chemotherapy prior elective surgery following SEMS is a relatively safe and feasible approach in the treatment for obstructive left hemicolon cancer, and is associated with less stoma, more laparoscopic surgery, shorter operative time, less blood loss, lower surgical difficulty, and faster postoperative recovery as compared with conventional elective surgery.

"Effect of ""Foot exercises"" on peripheral neuropathy and plantar pressure in patients with diabetic foot" / 现代临床护理

Objective To observe the effectiveness of routine nursing plus foot exercise on the peripheral neuropathy and plantar pressure in patients with diabetic foot.Methods Toally 100 patients with diabetic foot were randomly divided into 2 groups.On the basis of routine nursing care,50 patients in the observation group were given foot exercises for 12 weeks,50 patients in the control group were given routine nursing only.Before and after intervention,the Toronto clinical scoring system (TCSS),left and right foot peak pressure variation were observed.Results Before intervention,there was no statistical difference between the two groups' TCSS sore and the peak pressure of left and right foot (P ＞0.05).After intervention,the observation group's average total score of TCSS was lower,there was significantly different between two groups (P＜ 0.001).The peak pressure of left and right foot is lower in the observation group,the difference was statistically significant (P ＜ 0.05).Conclusion Foot exercises is worthy of clinical promotion,because it can improve the peripheral neuropathy of patients with diabetic foot,so as to reduce the plantar pressure,reduce the pain of patients and improve their life quality.

Clinicopathological features and risk factors of lymph node metastasis of gastrointestinal neuroendocrine neoplasms in 467 patients / 中华消化外科杂志

Objective To investigate the clinicopathological features and risk factors of lymph node metastasis of gastrointestinal neuroendocrine neoplasms (GI-NENs).Methods The retrospective case-control study was conducted.The clinicopathological data of 467 patients with GI-NENs who were admitted to the Fourth Hospital of Hebei Medical University from January 2006 to December 2015 were collected.Observation indicators:(1) occurrence sites and pathological classification of GI-NENs;(2) pathological characteristics of surgical specimens of GI-NENs;(3) univariate analysis and multivariate analysis affecting lymph node metastasis of GI-NENs:sex,age,tumor location,tumor diameter,pathological classification,pathological stage and tumor invasive depth.The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.Results (1) Occurrence sites and pathological classification of GI-NENs:of 467 patients with GI-NENs,tumors of 304,15,7,14 and 127 patients were located at stomach,duodenum,small intestine,colon and rectum,respectively.Tumor diameter was 0.3-12.0 cm,with an average diameter of 2.2 cm.Of 467 patients with GI-NENs,G1 and G2 of neuroendocrine tumors (NETs),G3 of neumendocfine carcinomas (NECs) and mixed adenoneuroendocfine carcinomas (MANECs) were respectively detected in 209,64,146 and 48 patients.Lymph node metastasis rate of GI-NENs was 31.48％ (147/467).(2) Pathological characteristics of surgical specimens of GI-NENs:NETs were high-differentiated NENs.Ceils of NETs were solid and nest-,trabeculum-and tubular-shaped,and consisted of small or medium cells,with moderate amount or massive cytoplasms,round or oval nucleus,particle-shaped chromatin,unobvious nucleolus and positive endocrine markers.There were abundant of small blood vessels and surrounding fibrous stroma in peripheral tumor cell nests.NECs were low-differentiated NENs and included small cell carcinoma and large cell NEC.Cells of small cell carcinoma were small round or oval and looked similar to lymphocytes,with few amount cytoplasms,fine granularshaped or hyperchromatic nucleus and common mitosis figures.Cells of large cell NEC were large and greater than 3 lymphocytes,arrayed in organoid-or chrysanthemum-shape,with massive cytoplasms,coarse particle-shaped chromatin,obvious nucleus,clear mitosis figures and large laminar-shaped necrosis.There were different positive expressions of endocrine markers between small cell carcinoma and large cell NEC.MANECs had the characteristics of glandular cavity formation of traditional adenocarcinoma and NENs.Results of immunohistochemical staining in 467 patients showed that Ki-67 of 467 patients was positive;CD56 in 379 of 428 with CD56 test was positive;synaptophysin (Syn) in 416 of 422 with Syn test was positive;cytokeratin (CK) in 354 of 396 with CK test was positive;chromogranin (CgA)in 264 of 388 with CgA test was positive;neuron specific enolase (NSE) in 287 of 346 with NSE test was positive.(3) Univariate analysis and multivariate analysis affecting lymph node metastasis of GI-NENs:results of univariate analysis showed that sex,tumor location,tumor diameter,pathological classification,pathological satge and tumor invasive depth were related factors affecting lymph node metastasis of patients with GI-NENs (X2 =20.654,18.182,26.788,184.709,163.738,195.391,P＜ 0.05).Results of multivariate analysis showed that pathological classification and pathological stage were independent influenced factors affecting lymph node metastasis of patients with GI-NENs (HR =2.129,7.171,95％ confidence interval:1.273-3.561,-2.327-22.098,P＜0.05).Conclusions GI-NENs are mostly located on the stomach and rectum.Results of immunohistochenical staining could help diagnosis of GI-NENs.Pathological classification and pathological stage are independent influenced factors affecting lymph node metastasis of patients with GI-NENs.

Clinical analysis of the effect of Rhodiola kirilowii Regel combined with calcium dobesilate in the treatment of early diabetic nephropathy / 中国基层医药

Objective To explore the effect of Rhodiola kirilowii Regel combined with calcium dobesilate in the treatment of early diabetic nephropathy.Methods 80 patients with early diabetic nephropathy were selected,and they were divided into treatment group and control group according to the digital table,40 cases in each group.The two groups were given diet control and appropriate exercise and positive controlled blood sugar,blood fat,blood pressure.The control group was given calcium dobesilate,based on this,the treatment group was given Rhodiola kirilowii Regel 10mL into 5％ glucose injection 250mL and 3 unit insulin to intravenous drip.The period of treatment was fifteen days.The UAER,Scr and BUN were compared between two groups before treatment and fifteen days after treatment.Results Before treatment,the Scr,BUN and UAER in the control group were (88.00 ± 18.19) μmol/L,(5.98 ± 1.92) mmol/L,(123.31 ± 60.01) μg/min respectively,which in the treatment group were (85.80 ± 18.31) μmol/L,(5.96 ± 1.94) mmol/L,(140.21 ± 62.92) μg/min respectively,there were no statistically significant differences between the two groups(t =-1.191,-0.016,0.432,all P ＞0.05).After treatment,the Scr,BUN and UAER in the control group were (84.61 ± 11.71) μmol/L,(6.30 ± 1.37) mmol/L,(97.81 ± 49.16) μg/min respectively,which in the treatment group were (75.60 ± 11.44) μmol/L,(5.25 ± 1.24) mmol/L,(39.81 ± 23.43) μg/min.There were no statistically significant differences in Scr and BUN of the two groups compared with before treatment (the control group:t =0.767,-0.657;the treatment group:t =1.947,1.219,all P ＞ 0.05).There was statistically significant difference in UAER of the two groups compared with before treatnent (t =2.850,5.402;P =0.046,0.006),but UAER of the treatment group after treatment decreased significantly.After treatment,there were no statistically significant differences in Scr and BUN between the two groups (t =-1.229,-1.236,all P ＞ 0.05),while there was statistically significant difference in UAER between the two groups (t =-2.394,P =0.044).The effective rate in the treatment group was 87.5 ％,which was higher than 57.5 ％ of the control group (x2 =9.028,P ＜ 0.05).Conclusion Rhodiola kirilowii Regel combined with calcium dobesilate can ameliorate protenuria and improve renal function of the patients with early diabetic nephropathy.

Therapeutic Effect of Shenluo'an Decoction for Obese Patients with Early Diabetic Nephropathy and Its Anti-inflammation Mechanism / 广州中医药大学学报

Objective To observe the therapeutic effect of Shenluo'an Decoction(SD) for the treatment of obese patients with early diabetic nephropathy and to explore the possible mechanism.Methods A total of 68 obese patients with early diabetic nephropathy were randomly assigned into control group and treatment group,34 cases in each group.Both groups were given conventional western medicine treatment including lifestyle regulation,dietary control,and medicine for lowering blood pressure,blood glucose and blood lipids.Additionally,the control group was given oral use of Irbesartan,and the treatment group was given oral use of SD combined with Irbesartan.Before and after treatment,we observed the traditional Chinese medical syndrome scores,body mass index(BMI),blood levels of cystatin C (Cys C),β2-microglobumin(β2-MG),homocysteine (Hcy) and fasting blood glucose (FBG),and urine parameters of urinary monocyte chemoattractant protein-1 / urinary creatinine (UMCP-1/UCR),urinary factor of regulated on activation in normal T cell expressed and secreted / urinary creatinine (URANTES/UCR),urinary albumin-to-creatinine ratio (UACR) and urinary albumin excretion ratio (UAER) before treatment and after treatment for 16 weeks.After treatment,the clinical efficacy and safety were also evaluated.Results (1) During the treatment,5 cases were dropped out,and a total of 63 cases (32 from the treatment group and 31 from the control group) completed the experiment.(2) The total effective rate of the treatment group(90.6％) was significantly higher than that of the control group(67.7％),the difference being significant(P ＜ 0.05).(3)BMI of the two groups after treatment was significantly lower than that before treatment (P ＜ 0.05).(4) After treatment,the traditional Chinese medical syndrome scores,blood parameters (Cys C,β2-MG,Hcy,FBG) and urine parameters (UMCP-1/UCR,URANTES/UCR,UACR,UAER) in the treatment group were decreased as compared with those before treatment and those in the control group after treatment(P ＜0.05).(5) A positive correlation was present among the parameters of UMCP-1/UCR,URANTES/UCR,UACR and UAER.(6) No abnormal changes took place in the blood and stool routine examination,hepatic function,or electrocardiography of the 63 cases.Conclusion SD combined with western medicine exerts certain therapeutic effect for obese patients with early diabetic nephropathy,and is effective on relieving clinical symptoms anddecreasing BMI,Cys C,β2-MG,UACR,UAER,UMCP-1 and URANTES.Its mechanism is probably related with the inhibition of chronic renal inflammation.