Chief Physician WANG Hui-reng is one of the second batch of national prestigious TCM experts. He has been engaged in medical services over 40 years and is adept in preventing and treating the chronic obstructive pulmonary disease (COPD) under the direction of prophylactic treatment, which emphasizes the control of risky factors of COPD, striving for protecting the healthy body, preventing the transmission of the disease and the recurrence after healing.

Objective: Traditional Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy can greatly decrease the anastomosis-related complications and reduce the incidence of reflux esophagitis, but its complexity limits the wide application. To decrease the complexity of Kamikawa anastomosis, the surgical team of Changzhi People's Hospital of Shanxi Changzhi Medical College improved this technique by using novel notion and reduced surgical procedures. This study aims to evaluate the efficacy and safety of modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy. Methods: A descriptive cohort study was carried out. Case enrollment criteria: (1) upper gastric carcinoma or esophagogastric junction carcinoma without distant metastasis was confirmed by preoperative gastroscopic biopsy and imaging examination; (2) tumor diameter was less than 4 cm; (3) preoperative clinical staging was cT1-3N1M0. Exclusion criteria: (1) patients received preoperative neoadjuvant chemotherapy; (2) patients had severe heart or lung disease, or poor nutritional status so that they could not tolerate surgery. Clinical data of 25 patients with upper gastric carcinoma or esophagogastric junction carcinoma who underwent modified Kamikawa anastomosis in digestive tract reconstruction in Heji Hospital (8 cases) and Changzhi People's Hospital (17 cases) from April 2019 to December 2020 were retrospectively collected. Of 25 patients, 21 were male and 4 were female, with mean age of 63.0 (49 to 78) years; 3 underwent open surgery and 22 underwent laparoscopic surgery. The modified Kamikawa anastomosis was as follows: (1) the novel notion of total mesangial resection of the esophagogastric junction was applied to facilitate the thorough removal of lymph nodes and facilitate hand-sewn anastomosis and embedding; (2) the diameter of the anastomotic stoma was selected according to the diameter of the esophageal stump, between 2.5 and 3.5 cm, to reduce the occurrence of anastomotic stenosis; (3) an ultrasonic scalpel was used to incise the esophageal stump, which could not only prevent bleeding of the esophageal stump, but also closely seal the esophageal mucosa, muscle layer and serosa to prevent esophageal mucosa retraction; (4) barbed suture was used to suture the remnant stomach fundus and esophagus to fix the stomach fundus in order to reduce the cumbersome and difficult intermittent sutures in a small space; (5) two barbed sutures were used to continuously suture the front and back walls of the anastomosis and complete the suture and fixation of the muscle flap. Relevant indicators of surgical safety, postoperative complications (using the Clavien-Dindo classification), esophageal reflux symptoms and the occurrence of esophagitis (using Los Angeles classification) were analyzed. The gastroesophageal reflux disease (GERD) score, gastroscopy, multi-position digestive tract radiography during postoperative follow-up were used to evaluate the residual gastric motility and anti-reflux efficacy. Results: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy was successfully performed in 25 patients. The surgical time was (5.8±1.8) hours, the intraoperative blood loss was (89.2±11.8) ml, and the average hospital stay was (13.8±2.9) days. Three cases (12.0%) developed postoperative anastomotic stenosis as Clavien-Dindo grade III and were healed after endoscopic dilation treatment. Postoperative upper gastrointestinal radiography showed 1 case (4.0%) with reflux symptoms as Clavien-Dindo grade I. Gastroscopy showed no signs of reflux esophagitis, and its Los Angeles classification was A grade. No anastomotic bleeding, local infection and death were found in all the patients. At postoperative 6-month of follow-up, GERD score showed no significant difference compared to pre-operation (2.7±0.6 vs. 2.4±1.0, t=-1.495, P=0.148). Conclusion: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy is safe and feasible with good anti-reflux efficacy.
Aged ; Anastomosis, Surgical ; Cohort Studies ; Esophagogastric Junction/surgery* ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Retrospective Studies

With the gradual increase in the diagnosis rate of early gastric cancer, clinicians must consider prevention of gastric anatomical structure and physiological function while ensuring the radical treatment of the tumor. Pylorus-preserving gastrectomy is a function- preserving operation that preserves the pylorus, inferior pyloric vessel, and the vagus nerve in patients with early middle gastric cancer. One of the major controversies at present is the thoroughness of limited lymph node dissection for pyloric-preserving gastrectomy. Various studies have reported that the lymph node metastasis rate of early middle gastric cancer was low, especially in the suprapyloric region, inferior pylorus and the upper pancreatic region. Partial lymph node dissection is required for vascular and neurological protection, which is also safe and feasible in studies reported by major centers. Many clinical studies have been carried out in Japan and Korea, and postoperative follow-up has gradually increased evidence, providing the basis for the safety of lymph node dissection. In large case studies comparing pylorus- preserving gastrectomy with traditional distal gastrectomy, the incidence of postoperative morbidity, such as dumping syndrome, bile reflux esophagitis, weight loss, and malnutrition is low. Sentinel lymph node navigation technology is gradually applied to the diagnosis and treatment of early gastric cancer, and its clinical application value still needs further research.
Humans ; Pylorus/pathology* ; Stomach Neoplasms/pathology* ; Gastrectomy ; Gastroenterostomy ; Lymph Node Excision

Based on the high solubility of azodicarbonamide (ADC) in hot solution and its electrostatic interaction with Nafion film,a new electroanalytical method was developed for the determination of ADC by using Nafion film electrode.The effect of temperature on the solubility of ADC and the mechanism of the reduction reaction of ADC on Nafion film electrode were investigated.Under the experimental conditions such as water bath at a constant temperature of 80 ℃,pH 6.0 and optimal test parameters,the differential pulse voltammetric response was proportional to the concentration of ADC in the range of 0.93-10.5 μg/L,and the detection limit was estimated to 0.58 μg/L.The relative standard deviation was less than 5.86 ％ and the recovery was 95.8％-104.0％ for the determination of the ADC in flour samples.The semicarbazide and nitrofurazone did not interfere with the determination of ADC.

Objective To determine and compare the minimum local analgesic concentration(MLAC) of ropivacaine and bupivacaine in continuous block of axillary brachial plexus for postoperative active mobilization of flexor tendon. Methods Seventy ASA Ⅰ or Ⅱ patients undergoing relaxation of flexor tendon were randomly allocated into 2 groups (n = 35 each): ropivacaine group (group R) and bupivacaine group (group B). A catheter was inserted into axillary sheath using B. Braun stimulating intraducer, 24-48 h after operation. 30 min before functional exercise 20 ml of ropivacaine or bupivacaine was injected through catheter. The minimum local analgesic concentration of both local anesthetics was determined by up-and-down sequential test. The first concentration of both local anesthetics was 0.1%. The next concentration of local anesthetic was determined by response of the previous patient. The analgesia efficacy was assessed using 100 mm VAS score (0 = no pain, 100 mm = worst possible pain) . Increase/decrease in VAS by 10 mm was defined as effective. An effective result resulted in increase/decrease by 0.01% in the next patient. The motor block was also recorded.Results The two groups were comparable with regard to age, sex, body weight and baseline VAS score. The MLAC of ropivacaine was 0.133% [95% confidence interval (CI), 0.128%-0.138%] and MLAC of bupivacaine was0.121% (95%CI, 0.116%-0.126%). The analgesic potency of ropivacaine was 10% less than that of bupivacaine. The potency ratio of ropivacaine to bupivacaine was 0.91. The degree of motor block is higher with bupivacaine than with ropivacaine. Conclusion The results of our study show that the analgesic potency of ropivacaine is 10% less than that of bupivacaine. The degree of motor block is higher with bupivacaine than with ropivacaine.

OBJECTIVE: A remote multi-part personal radiation dose detection system is designed with ATmega32A single chip microcomputer as the control core. METHODS: First of all, the geiger counter tube module collects the radiation signal of the surrouding environment. Secondly, using ATmega32A Microprocessor of Slave computer to calculate the collected signal. Finally, it is sent to the host receiving device or mobile APP through Bluetooth module,so as to realize real-time detection of radiation data, remote transmission and security alarm. RESULTS: The system is measured in the same environment as the RG1100 radiometer, with a maximum difference of 0.03 μSv/h.This shows that it can stably realize the functions of radiation measurement, monitoring, alarm, remote connection and multimodal display. CONCLUSIONS The system has the advantages of good portability (easy to carry), low power consumption, accurate measurement and so on. It has certain reference value and practicability.
Equipment Design ; Microcomputers ; Radiation Dosage ; Wireless Technology

With the increasing detection rate of early upper gastric cancer and adenocarcinoma of esophagogastric junction, the safety of proximal gastrectomy with clear indications has been verified, and function-preserving proximal gastrectomy has been widely used. However, proximal gastrectomy destructs the normal anatomical structure of esophagogastric junction, resulting in severe postoperative gastroesophageal reflux symptoms and seriously affecting the quality of life. Among various anti-reflux surgery methods, reconstruction of "cardiac valve" has always been the focus of relevant scholars because its similarity with the mechanism of normal anti-reflux. After years of development, evolution and optimization, the designed seromuscular flap anastomosis includes tunnel muscle flap anastomosis, Hatafuku valvuloplasty, single muscle flap anastomosis and double muscle flap anastomosis. The double muscle flap anastomosis has become a research hotspot because it shows good anti-reflux effect in clinical application. This paper reviews the history, research status and hot issues of seromuscular flap anastomosis of esophageal remnant stomach at home and abroad.
Anastomosis, Surgical/methods* ; Esophagogastric Junction/surgery* ; Gastrectomy/methods* ; Gastroesophageal Reflux/surgery* ; Humans ; Quality of Life ; Stomach Neoplasms/surgery*

Objective: To analyze the expressions of coordinated stimulating molecular programmed death 1(PD-1) and programmed death ligand 1 (PD-L1) in human glioma and their clinical significances. Methods: A total of 70 postoperative paraffin specimens of brain glioma and 35 normal brain tissues in Heji Hospital Affiliated to Changzhi Medical College from January 2013 to December 2017 were collected. The expressions of PD-1 and PD-L1 in 70 glioma tissues and 35 normal brain tissues were detected by immunohistochemical SP method. The relationship between the expressions of PD-1 and PD-L1 and their correlation with the clinicopathological features were analyzed. Results: The positive expression rates of PD-1 and PD-L1 in glioma tissues were 69% (48/70) and 62% (43/70), respectively, which were higher than those in normal brain tissues [29% (10/35), 31% (11/35)], the differences were statistically significant (χ² values were 15.099 and 8.407, both P < 0.05). The positive expression rates of PD-1 and PD-L 1 in high-grade glioma were 81% (30/37) and 73% (27/37), respectively, which were higher than those in low-grade glioma [55% (18/33) and 49% (16/33)], the differences were statistically significant (χ ² values were 5.699 and 4.415, both P < 0.05). There was no significant difference in the positive expression rates of PD-1 and PD-L1 among patients with different sex, age and maximum tumor diameter (all P > 0.05). There was a positive correlation between the expressions of PD-1 and PD-L1 proteins in glioma tissues (r= 0.372, P= 0.002). Conclusions The PD-1 and PD-L1 may become new biological indicators for evaluating the occurrence and development of glioma.

The quality control and standardization of procedures in radical gastrectomy for gastric cancer, especially the standardized processing of specimens after radical gastrectomy for gastric cancer, is very important. It is not only the basis of accurate pathological staging, but also the evidence of surgical quality and the original data of clinical research, which plays a pivotal role. The examination and classification of lymph nodes, specimens processing records, and data uploading and archiving after radical gastrectomy for gastric cancer are indispensable. It is necessary for surgeons to participate in the processing of surgical specimens. This article will combine the current research status and progress at home and abroad to review the standardized processing of specimens after radical gastrectomy for gastric cancer.
Gastrectomy ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Neoplasm Staging ; Stomach Neoplasms/surgery*

Animals ; Carbon Tetrachloride ; toxicity ; Dinoprostone ; blood ; Ginsenosides ; pharmacology ; therapeutic use ; Liver ; ultrastructure ; Liver Cirrhosis, Experimental ; drug therapy ; enzymology ; immunology ; Male ; Panax ; Phospholipases A ; biosynthesis ; genetics ; Phospholipases A2 ; RNA, Messenger ; analysis ; Rats ; Rats, Wistar ; Tumor Necrosis Factor-alpha ; biosynthesis