Complications in CRF-CAPD were treated by TCM during the past 17 years. Loss of appetite and hypoproteinemia were treated with modified Renshen Yangrong Decoction, for abdominal pain and distention, modified Xiangsha Liujunzi Decoction; for peritonitis, modified Dacaihu Decoction; for diarrhea due to hypofunction of spleen with exuberant dampness, modified Shenling Baizhu Powder; for Yang-deficiency of the Spleen and Kidney, modified Lizhong Decoction plus Sishen Pill; for skin pruritus, Siwu Decoction with additives; for renal -ortheopathy, treated by principles of tonifying the liver - kidney, strengthening the bones and tendons and blood - activating and stasis - relieving; for hyperlipidemia, by principles of tonifying the liver -kidney, phlegm and turbidity - eliminating and blood - activating stasis - relieving; for renalanemia, Guishao Sijunzi Decoction with additives. To improve patient'sliving quality and nutrition, self- formulated Shentekang capsule was given to improve renal function, decrease the frequencies and duration of dialysis, self - formulated Shenshuai Recipe was administered.

Objective To explore risk factors of different locational leukoaraiosis in elderly patients with cerebral infarction.Methods Patients were collected who aged 60 to 85 with cerebral infarctions came to the Fourth Affiliated Hospital of China Medical University and took cerebral magnetic resonance imaging (MRI) [fluid-attenuated inversion recovery (FLAIR), T1, and T2].The patients were divided into periventricular white matter changes (PVWMCs) and deep white matter changes (DWMCs), and scored by Fazekas scale, respectively.We registered past medical history, medical systems and neurological examination, blood lipids, regular blood test, and resting blood pressure measurements in the morning.Univariate analysis was used to choose risk factors which ~fected white matter changes.After that, rank multivariate logistic regression analysis was used to test risk factors of PVWMCs and DWMCs, respectively.Results There were significant age differences in both PVWMCs and DWMCs, the degree of risk was associated with age.Conclusions PVWMCs and DWMCs risk factors vary, and we should take control of risk factors actively for the elderly in order to reduce the harm arising from WMC.

Objective To evaluate the efficacy and safety of continuous suture by QuillTM SRS self-retaining suture for closing choledoch incision. Methods From January 2015 to October 2015, 66 patients with gall bladder calculi combined with common bile duct stones who received laparoscopic gallbladder excision, common bile duct explo-ration, laparoscopy choledochotomy, suture choledoch immediately were randomly divided into two groups, experi-mental group using QuillTM SRS self-retaining suture for closing choledoch incision and control group using tradi-tional absorbable suture for closing choledoch incision. Then observe the operation time, the risk of bile leakage oc-curred in the operation and the risk of bile leakage after operation. Results All patients successfully completed in laparoscopic surgery without laparotomy. Operation time, the risk of bile leakage occurred during operation in exper-imental group has statistically significant difference compared with control group ( < 0.05). The operation time and incidence of intraoperative bile leakage of the experimental group was less and lower than control group, while the risk of bile leakage after operation show no statistically difference ( >0.05). Conclusion Compared with interrupted suture by normal sutures, continuous suture by QuillTM SRS self-retaining suture for closing choledoch incision has the characteristics of shorter operation time and lower incidence of intraoperative and postoperative bile leakage. It is worthy of promoting.

OBJECTIVETo evaluate the effect and safety of acupuncture combined with Jiawei Mojie tablet for the prevention of endometriosis recurrence after surgery.

METHODSOne hundred and six patients after the conservative surgery against endometriosis were randomly divided into a western medication group and an acupuncture and medication group(a combination group), 53 cases in each one. In the western medication group, gestrinone was applied orally. In the combination group, acupuncture and Jiawei Mojie tablet with oral administration were adopted. Xuehai (SP 10), Sanyinjiao (SP 6) and Guanyuan (CV 4) were mainly used, and acupoints based on syndrome differentiation were combined. After the surgery and when the menstruation was end, 3 to 5 days later the preventive treatment was used successively for 6 months. Patients were followed up after treatment and in 3 months, 6 months, and 18 months (two years after surgery) after treatment. The recurrence [Abdominal/perineal ultrasonic examination, serum cancer antigen 125 (CA125) test], menstruation score, endometriosis health profile-5 (EHP-5) and the safety index of serum alanine aminotransferase (ALT) were compared between the two groups.

RESULTSEight patients (five cases in the western medication group and three cases in the combination group) were rejected because of dropping, and six ones (two cases in the western medication group and four cases in the combination group) discontinued. When patients were followed up in 18 months after treatment, the suspected recurrence rate through ultrasonic examination was 2.0% (1/50), and the unusual rate of serum CA125 text was 4.0% (2/50) in the combination group, which were apparently lower than 18.8% (9/48) and 25.0% (12/48) in the western medication group (both P < 0.01). After treatment and 3-month, 6-month, and 18-month following up, the menstruation scores of the combination group were obviously lower than those of the western medication group (P < 0.01, P < 0.05). After 18 months, the positive rate of EHP-5 in the combination group was 0 (0/50), which was markedly lower than 18.8% (9/48) in the western medication group (P < 0.01). After treatment and 3-month, 6-month, and 18-month following up, the unusual rates of serum ALT text in the combination group were lower than those in the western medication group (P < 0.01, P < 0.05). After treatment, the unusual rate of serum ALT text was not significantly different in the combination group compared with that before treatment (P > 0.05), and after treatment and 3-month, 6-month following up, the unusual rates of serum ALT text in the western medication group were remarkablely higher than those before treatment (P < 0.01, P < 0.05). After 18-month following up, the unusual rate of serum ALT text in the western medication group was not statistically significant compared with that before treatment (P > 0.05).

CONCLUSIONAcupuncture combined with Jiawei Mojie tablet can effectively prevent endometriosis recurrence after surgery, and improve menstruation condition and life quality, which are less injurious for liver than gestrinone.

Acupuncture Points ; Acupuncture Therapy ; Administration, Oral ; Adult ; CA-125 Antigen ; blood ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; Endometriosis ; blood ; drug therapy ; prevention & control ; surgery ; Female ; Humans ; Male ; Recurrence ; Young Adult

Objective To investigate the clinical effect of laparoscopic reverse papillary intubation through cystic duct and laparoscope combined with duodenoscope in the treatment of cholecystolithiasis and thining choledocholithiasis.Methods The retrospective cohort study was adopted.The clinical data of 192 patients with cholecystolithiasis and thining choledocholithiasis who were admitted to Chengdu Second People's Hospital between May 2012 to August 2015 were collected.The 96 patients who underwent laparoscopic reverse papillary intubation through cystic duct were allocated into the case group,and the other 96 who received surgery by laparoscope combined with duodeuoscope were allocated into the control group.All the patients underwent laparoscopic cholecystectomy (LC) according to routine approaches.The 96 patients in the case group received the placement of 4 Fr ureter catheter via cystic duct and placement of common bile duct inserted through the duodenal papilla under laparoscope,and then the duodenal papilla was resected using needle knife along the ureter catheter and stones were removed by basket lithotriptor and ball lithotriptor.The 96 patients in the control group received the intubation using the bow knife with zebra guidewire,and stones were removed by basket lithotriptor and ball lithotriptor.During the operations,it was observed whether there were residual stones by nasobiliary radiograph.The comparison was made between the 2 groups concerning (1) surgical situation:intubation and operation time.(2) Postoperative alanine transaminase (ALT),postoperative aspartate transaminase (AST),postoperative total bilirubin (TBil),postoperative blood amylase,postoperative lipase,complications and extubation time.(3) Situation of follow-up:follow-up was done by outpatient examination or telephone interview up to November 2015.The stones recurrence was detected by retrograde cholangiography through nasal bile duct,magnetic resonance cholangiopancreatography (MRCP) or ultrasonic examination.Measurement data with normal distribution were represented as x ± s.Comparison between groups was done by the t test.Count data were analyzed by the chi-square test.Results (1) Surgical situation:2 groups both underwent successful LC.Ureteral catheter in the case group was successfully imbedded through cystic duct,including 8 patients with being difficult to intubate.Five patients in the control group were failed in endoscopic sphincterotomy (EST) due to periamullary diverticula or other causes,and then EST was performed again by the duodenal papilla through ureteral catheter which was intubated through cystic duct.Operation time of the case group and control group was (89 ± 17) minutes and (105 ± 26) minutes,respectively,with a statistically significant difference between the 2 groups (t =5.05,P ＜ 0.05).(2) Postoperative situation:ALT,AST,TBil of the case group and control group were (163 ±54)U/L,(87 ±38)U/L,(43 ± 18)tmol/L and (147 ±49) U/L,(101 ± 26) U/L,(37 ± 17) μmol/L,respectively,showing no statistically significant differences (t =0.97,1.21,0.84,P ＞ 0.05).Postoperative blood amylase and lipase of the case group and control group were (151 ± 41) U/L,(198 ± 72) U/L and (395 ± 142) U/L,(549 ± 217) U/L,respectively,showing statistically significant differences (t =16.18,15.05,P ＜ 0.05).No pancreatitis was found in the case group while 6 patients in the control group complicated with mild pancreatitis were improved by symptomatic treatment of fasting,somatostatin administration and acid suppression,with no severe pancreatitis.No complications such as intestinal perforation,bile duct perforation and massive hemorrhage were detected in both groups after operation.No death occurred.The nasal bile duct in the patients without pancreatitis was removed at postoperative day 3.The nasal bile duct in the patients with pancreatitis was removed after the remission of abdominal pain and diet intake.In the case group,it was difficult to remove the nasal bile duct of 1 patient.Nasal bile duct radiograph showed that the bending section of nasal bile duct was mistakenly sutured by the absorbable thread at the lower margin of incision of junction of cystic ducts,and yet there was unobstructed biliary drainage.The nasal bile duct was removed and the patient was discharged from hospital at postoperative day 19.The abdominal drainage tubes were removed at postoperative day 3 to5 in both groups.(3) Of 192 patients,151 were followed up for a median time of 10 months (range,3-12 months).Patients had good recovery without recurrence of abdominal pain,jaundice and stones.Conclusion Laparoscopic reverse papillary intubation through cystic duct for the treatment of cholecystolithiasis and thining choledocholithiasis is safe and feasible,and it can also reduce incidence of pancreatitis after nasobiliary drainage.

Objective To explore the expression and clinical significance of microRNA (miR)-155 and miR -222 in plasma of patients with ventricular septal defect(VSD),and to analyze the possible mechanism.Methods A total of 20 children with VSD who received treatment at the Department of Cardiovascular Surgery from August 2012 to June 2013 were enrolled (the VSD group)and 15 patients with fracture (the control group).The plasma miR -155 and miR -222 expression levels were measured by real -time quantitative reverse transcription -polymerase chain reaction (RT -qPCR).The potential target genes of miR -155 and miR -222 were predicted by using 3 current-ly available prediction programs,including TargetScan,mirbase and Miranda,and the signaling pathway of miRNA was predicted by Pathway -express analysis.Results Compared with the control group,the expression levels of miR -155 (P =0.033)and miR -222(P <0.001)in the VSD group decreased significantly;miR -155 and miR -222 predic-ted target genes included 74 and 50,respectively.The Pathway -express analysis indicated that 7 signaling pathways played important roles in the occurrence of fetal VSD,including signaling pathways for heart development,such as:mito-gen -activated protein kinase(MAPK)signaling pathway.Conclusions The expression levels of plasma miR -155 and miR -222 in VSD were significantly decreased.The target genes were related to signaling pathways for heart deve-lopment (MAPK signaling pathway),which indicates that miR -155 and miR -222 may be involved in the pathological process of VSD,and may serve as an independent evaluation indicator for the diagnosis of VSD.

Objective To analyze the clinical characteristics,pathology,CT characteristics and targeted therapy of primary retroperitoneal leiomyosarcoma treated at our institution during the past 20 years.Methods A retrospective review was performed among 11 patients of this disease.The main performances were hematuria,abdominal mass and abdominal pain.Non-enhanced CT scanning showed soft tissue density in all cases.Tri-phase enhanced scanning showed reinforcement in different degrees.Pathology results showed tissue necrosis.The pathology featured by routine HE and immumohistochemical staining.Results Surgical treatment was performed in all 11 patients.Postoperative pathology showed that median tumor diameter was 14.40cm.Spindle cell,cellular abnormity and mitotic figures could be seen through light microscope.During follow-up,3 cases recurrenced after 2 months,3 years and 5 years respectively.Conclusions Primary retroperitoneal leiomyosarcoma might have a high fatality rate and high recurrence rate.The clinical and CT features are unapparent.Pathology diagnosis is reliable,surgery is necessary to prolong life and cure disease.

Objective To explore the feasibility and curative effect of extracellular matrix (ECM) fibrinolytic therapy in order to cure radiation-induced brachial plexopathy (RIBP) and to discuss the principle, indication and precautions. Methods The treatment was taken on 16 cases that had a definite clinical diagnosis and we took a systematic examination to make sure that there was no recurrence or metastasis of the tumor.Brachial plexus and tender area block was taken once a week by injection of mixture of hyaluronidase, hexadecadrol, Vitamine B12 and lidocaine. The therapy was applied for 6 to 12 weeks. Results All the patients were followed up for a period of 0.5 to 10 years. Four cases had an evident alleviation of the symptoms and got a function resumption of hands; 5 cases had an alleviation of pain and improvement of sensation and the progress of illness were terminated, but motor function didn't have improvement; 7 cases had a continued aggravation of the symptoms. All the cases found improvement in electromyography. Concluslon The aim of fibrinolytic therapy is to dissolve the extra ECM such as hyaluronic acid around nerves in order to achieve a new homeostasis. It can relieve the conglutination and entrapment at nerve inside and outside, reduce the pressure of neuraxon and create an availing condition for the regenesis of nerve and the regain of function.

Objective: To observe the effects of acupuncture on synovial pathology, synovial mast cell degranulation and tryptase expression and to investigate the relationship between the functions of mast cells and effects of acupuncture on early adjuvant arthritis in rats. Methods: Forty-six male Wistar rats were randomly divided into normal control group (n=16), untreated group (n=15) and acupuncture group (n=15). Adjuvant arthritis was induced by injection of 0.1 mL Freund's complete adjuvant in right hind limb footpad. Normal control group and untreated group received no acupuncture treatment, while rats in the acupuncture group were treated with sterilized disposable stainless steel needles inserted perpendicularly as deep as 2 to 3 mm at Xuanzhong (GB39), 6 mm at Shenshu (BL23) and 7 mm at Zusanli (ST36) for eight times (15 min each time) every two days. Setting the modeling day as the 0 day of the experiment, the body weight and paw volume of the rats were measured every three days from the 0 day. In the end, synovial tissues of the right hind ankles were sampled and made into paraffin sections. Then they were firstly stained with hematoxylin-eosin for observing synovial pathology to evaluate the effects of acupuncture on adjuvant arthritis, then stained with toluidine blue for observing the number and degranulation ratio of synovial mast cells and finally detected by immunohistochemical staining method to investigate the expression of tryptase in synovium. Results: Compared with the untreated group, the body weight of rats in the acpuncture group was increased significantly (P<0.05), while the paw volume decreased obviously (P<0.01). Hematoxylin-eosin staining showed that acupuncture significantly inhibited inflammatory cell infiltration, synovial cell hyperplasia, and synovial fibroplasia in synovium of rats with adjuvant arthritis as compared with the untreated group (P<0.05). Toluidine blue staining showed that acupuncture could significantly diminish the numbers of total and degranulated mast cells in rats with adjuvant arthritis (P<0.01), which were significantly higher in the untreated group than in the normal control group (P<0.01). Showing by immunohistochemical staining, the expression of tryptase in synovium in the acupuncture group was decreased as compared with the untreated group (P<0.01). Analyzed by Spearman's bivariate correlation, the number of mast cells and degranulation ratio of mast cells were positively correlated with the pathological scores (r=0.837, P<0.01; r=0.634, P<0.01). Conclusion: Acupuncture can improve pathological condition of inflammatory synovium in rats with early adjuvant arthritis by inhibiting the function of synovial mast cells, which may play an important underlying role in the immunoregulation of acupuncture on adjuvant arthritis.

Objective This study is aimed to explore the effect of rhTNFR:Fc and methotrexate (MTX)-rhTN FR:Fc on joint destruction of collagen-induced arthritis ( CIA ) rat by establishing CIA rat model which imitates pathogenic factors of rheumatoid arthritis (RA).Methods CIA rat model were developed by subcutaneous injection of bovine type Ⅱ collagen.The rats with inflammation scores of two or above were randomly divided into four groups:the sterilized water treatment group (0.4 ml/w,intra-peritoneal injection),the MTX treatment group (1 mg/w,intra-peritoneal injection),the rhTNFR:Fc treatment group(0.8 mg Biw,intra-peritoneal injection),the MTX + rhTNFR:Fc treatment group (MTX 1 mg/w and rhTNFR:Fc 0.8 mg Biw,intraperitoneal injection).After treatment for 8 weeks,the rats were sacrificed and took the ankle radiography.Micro-CT scan of proximal tibia was performed and hard-tissue slices were made,and then the ankle's bone damage of each group was observed in order to evaluate trabecular variation and bone quantity changes of proximal tibia.Statisstical analysis was conducted with ANK-q test.Results After treatment for 8 weeks,the percentage of trabecular area and the trabecular number of the rhTNFR:Fc treatment group and the MTX-rhTNFR:Fc treatment were [(29.1±0.3)％,(26.7±0.6)％,(4.4±0.5)/mm,(4.0±0.6)/mm] (P＜0.01),which were evidently higher than the sterilized water treatment group and MTX treatment group (P＜0.01).The trabecular separation of Etanercept treatment group and MTX-rhTNFR:Fc group was obviously less than the sterilized water treatment group and MTX treatment group [(12.9±0.5)％,(13.2±0.4)％ vs (2.0±0.3)/mm,(2.2t0.2)/mm] (P＜0.01).Conclusion rhTNFR:Fc and MTX-rhTNFR:Fc can remarkably inhibit joint destruction of CIA rat.And their effect on inhibiting of inflammation and increasing peri-articular bone quantity.In addition,they are effective on inhibiting the reduction of local trabecular structure and increase of trabecular separation.