ObjectiveTo observe the effect of Xuesaitong Capsule on stroke patients in recovery phase.Methods427 patients with stroke were randomly divided into 3 groups, group Ⅰ(take in aspirin), group Ⅱ(take in Xuesaitong), group Ⅲ(take both medicine). The Europe Stroke Scale (ESS), Barthel index (BI) and blood rheology were compared among these three groups.ResultsESS and BI score of group Ⅱ were higher than that of group Ⅰ, but lower than that of group Ⅲ. The recurrence rate and blood rheology index was similar in group Ⅰand Ⅱ, but higher than that of group Ⅲ.ConclusionBoth Xuesaitong Capsule and aspirin are effectivity on stroke in recovery phase, but it is better to take in both medicines.

Objective To provide the anatomical basis for the flap based on the perforator of Plantar arch,through investigation of the morphological features of the perforator of the arch of the foot.Methods From November,2015 to March,2016,the first metatarsal base and the fifth metatarsal tuberosity were chosen as the observation point on 25 specimens of adult human feet perfused with red latex.The following contents were observed under surgical magnifier:①The origin,courses,branches and distribution of the perforator of Plantar arch.②The anastomoses among the perforator of Plantar arch and the fete arteriosum dorsale pedis.Mimic operation was performed on another fresh specimen perfused with red latex.Results There were 3 perforators in Plantar arch,which passed through the 2nd-4th metatarsal dorsal muscles to the dorsi pedis and then divided into an ascending branch and a descending branch.The ascending branch anastomosed with the rete arteriosum dorsale pedis,and the descending branch stretched to the 2nd-4th plantar arteries.The initiative outer diameters of the 1st-3rd dorsal perforators of Plantar arch were (1.5 ± 0.3)mm,(1.1 ± 0.4) mm and (0.9-± 0.3) mm respectively,and the lengths of the stem were (1.1 ± 0.2) cm,(1.5 ± 0.1) cm and (1.5 ± 0.5) cm respectively.Conclusion The flap can be used for repair of soft-tissue defects of dorsal and front foot through dorsal transposition or a V-Y advancing flap with the perforator of Plantar arch as its vascular pedicle.

Objective To investigate the stress response and postoperative recovery state of vaginal(VH) versus abdominal hysterectomy(AH). Methods A total of 220 cases schedulced for total hysterectomy for benign disease were randomly divided into the VH and AH group,each consisting of 110 cases, receiving VH and AH respectively. Circulating blood glucose(Glu), IL-6, and CRP levels were measured preoperative-ly,2h and 1 day after operation between both two groups,and the operative duration,intraoperative blood loss,time of anal gas passage and postoperative hospital stay were compared between both two groups. Results The intraoperative blood loss,time of anal gas passage and post-operative hospital stay were markedly less in the VH group than in the AH group,with significant differences between two groups,all P <0.01 (t = 8.939,18.762, and 8.727 respectively), while the operative duration was not different, P> 0.05(t = 1.922). The serum IL-6 level was con-siderably lower 2h postopeartion in the VH group than in the AH group,and the levels of IL-6 and CRP 1 day after operation remained the same, with significant differences, all P < 0.01 (t =41.459, 16.711, and 24.281 respectively). No significant differences were noted at the other point between two groups,all P> 0.05. Conclusion VH proves to have less stress response as compared to AH,with better postoperative re-covery.

Objective To explore the feasibility of the perforator-based intermediate dorsal pedal flap with vessels of cutaneous nerve nutrition for repair of soft tissue defects of the forefoot.Methods A retrospective case series study was performed for seven cases of soft tissue defects of the forefoot hospitalized between February 2013 and January 2017.There were five males and two females,with a mean age of 38 years (range,18-73 years).Injury regions were lateral plantar skin defect in the forefoot in three cases,dorsal skin defect in the third webbed toe in two cases and proximal dorsal skin defect in the fourth toe in two cases.The defect area was about 2.5 cm × 1.5 cm-4.5 cm × 2.0 cm.The perforator-based intermediate dorsal pedal flap with vessels of cutaneous nerve nutrition was designed on the lateral dorsum of the foot and then was incised and transferred to repair the forefoot wound based on its surgical anatomy.The time of surgery and the amount of intraoperative blood loss were recorded.An observation was done on feeling,appearance,texture,blood supply and survival of the flap as well as swelling,hypertrophic scar,itching,paralysis of the skin grafting area.The recovery of the activity function was assessed by American Orthopedic Foot & Ankle Society (AOFAS) score.Results The surgery time was 1.0-1.5 h (mean,1 h),and intraoperative bleeding was about 50 ml (range,30-100 ml).Seven cases of perforator-based dorsal medial skin flap with vessels of cutaneous nerve nutrition all survived,with early wound healing.After 2 to 15 months follow-up,two-point discrimination of flaps was 9-15 mm(average,12.5 mm).Skin flaps were with excellent texture and without swelling,the color of which was close to normal color with good appearance.The postoperative foot did not have bone resorption,wound infection,tendon adhesion,line-type or flaky scar left locally,lower limb walking dysfunction or other complications.Patients were satisfied with the functions of donor and recipient sites and the appearance of the flap.Conclusions Perforation-based dorsal flap with vessels of cutaneous nerve nutrition has high survival rate,satisfaction of appearance and fast recovery of recipient site,with no obvious foot pain,limitation of joint movement or other complications,and therefore is a reliable method to repair soft tissue defects in forefoot.

Objective: To investigate the feasibility and safety of the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure. Methods: A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four-step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m². The medial approach "four-step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation" technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short-term clinical efficacy of this surgical procedure was summarized. Results: All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra-operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5±1.3) days, the postoperative hospital stay was (5.2±2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion The medial approach "four-step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.

Objective: To investigate the morphological characters of the dorsal perforators originated from the deep palmar arch, so as to provide anatomic basis for V-Y advanced perforator flap. Methods: The following contents were investigated in 30 adult hand specimens perfused with red latex under surgical magnifier: ①The origin, courses, branches and distribution of the dorsal perforators originatedd from the deep palmar arch. ②The characters of anastomosis among the dorsal perforators, the dorsal carpal and metacarpal arteries. Mimic operation was performed on another fresh specimens perfused with red latex. Results: There were three perforators originated from the deep palmar arch, which passed through the 2nd-4th dorsal interossei and then divided into an ascending branch and a descending branch at the dorsum of hand. Then the ascending branch anastomosed with the dorsal carpal artery, and the descending branch stretched to the 2nd-4th dorsal metacarpal arteries. The originating outer diameters of the 1st-3rd perforators were (1.1±0.2) mm, (0.9±0.3) mm and (0.7±0.1) mm respectively, and the length of the stems were (1.1±0.3) cm, (1.0±0.2)cm and (0.9±0.1) cm respectively. Conclusions The V-Y advanced perforator flap with the dorsal perforator of the deep palmar arch as its vascular pedicle could be used to repair the dorsal carpal or dorsal metacarpal soft tissue defects.

Objective To report the anatomy basis and clinical application of the flap based on the perforator of plantar arch.Methods From December 2013 to June 2016,25 cadaveric feet which were injected with a mixture of red gelatin were used to observe:the origins,courses,branches,distributions of the dorsal perforators flap based on the plantar arch;the anastomoses between the back perforators of plantar arch and rete arteriosum of dorsale pedis.Based on the anatomy research,11 cases with soft tissue defect at forefoot were treated with the perforator flaps.Results 11 flaps survived completely with primary healing.The flaps were followed up for 2-36 months with good match of texture and color.Conclusions The flap based on the perforator of plantar arch has constant and rich blood supply.The technique is easily performed and can be used as an optional flap without major vessel for defect at forefoot.

Objective To report the anatomy basis and clinical application of the flap based on the perforator of plantar arch.Methods From December 2013 to June 2016,25 cadaveric feet which were injected with a mixture of red gelatin were used to observe:the origins,courses,branches,distributions of the dorsal perforators flap based on the plantar arch;the anastomoses between the back perforators of plantar arch and rete arteriosum of dorsale pedis.Based on the anatomy research,11 cases with soft tissue defect at forefoot were treated with the perforator flaps.Results 11 flaps survived completely with primary healing.The flaps were followed up for 2-36 months with good match of texture and color.Conclusions The flap based on the perforator of plantar arch has constant and rich blood supply.The technique is easily performed and can be used as an optional flap without major vessel for defect at forefoot.

Objective To investigate the feasibility and safety of the medial approach "four?step method" in the laparoscopic mobilization of splenic flexure. Methods A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four?step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m2. The medial approach "four?step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation"technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short?term clinical efficacy of this surgical procedure was summarized. Results All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra?operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5 ± 1.3) days, the postoperative hospital stay was (5.2 ± 2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion The medial approach "four?step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.

Objective To investigate the feasibility and safety of the medial approach "four?step method" in the laparoscopic mobilization of splenic flexure. Methods A retrospective cohort study was performed. Clinical data of 157 colorectal cancer patients undergoing the medial approach "four?step method" in the laparoscopic mobilization of splenic flexure at Gastrointestinal Surgical Department of Guangdong Provincial People′s Hospital from July 2015 to June 2018 were retrospectively analyzed. Of 157 cases, 17 were transverse colon cancer, 94 were descending colon cancer, 25 were sigmoid cancer and 21 were rectal cancer; 89 were male and 68 were female; mean age was (61.8±10.3) years and mean body mass index was (23.2±3.7) kg/m2. The medial approach "four?step method" in the laparoscopic mobilization of splenic flexure was performed as follows: (1) The root vessels were treated with the "provocation"technique to expand the Toldt′s gap. This expansion was extended from the lateral side to the peritoneum reflex of left colonic sulcus, from the caudal side to the posterior rectal space, and from the cephalad side to the lower edge of pancreas. (2) The left colonic sulcus was mobilized, converging with the posterior Toldt′s gap. Mobilization was carried out from cephalad side to descending colon flexure, freeing and cutting phrenicocolic ligament and splenocolic ligament, and from caudal side to peritoneal reflex. (3) Gastrocolic ligament was moblized. Whether to enter the great curvature of stomach omentum arch when the gastrocolic ligament was cut, that was, whether to clean the fourth group of lymph nodes, should be according to the tumor site and whether serosal layer was invaded. (4) Transverse mesocolon was moblized and transected at the lower edge of the pancreatic surface, merging with the posterior Toldt′s gap, and from lateral side to lower edge of the pancreatic body, merging with the lateral left paracolonic sulcus. Safety and short?term clinical efficacy of this surgical procedure was summarized. Results All the patients completed this procedure. During operation, 3 cases were complicated with organ injury, including 1 case of colon injury, 1 case of spleen injury and 1 case of pancreas injury. No operative death and conversion to open surgery was found. The average operation time was (147.5±35.1) minutes, the average intra?operative blood loss was (40.8±32.7) ml and the average number of harvested lymph node was (16.1±5.8), including (4.0±2.3) of positive lymph nodes. The first exhaust time after surgery was (41.3±20.6) hours, the fluid intake time was (1.5 ± 1.3) days, the postoperative hospital stay was (5.2 ± 2.3) days. Eight (5.1%) cases developed postoperative complications, and all were improved and discharged after conservative treatments. According to the TNM classification system, postoperative pathology revealed that 31 patients were stage I, 51 were stage II, 53 were stage III, 22 were stage IV. Conclusion The medial approach "four?step method" is safe and feasible, which can effectively decrease the operation difficulty of the laparoscopic mobilization of the splenic flexure.