Objective To investigate the effect of enhanced recovery after surgery (ERAS) on stress hyperglycemia in patients after pancreaticoduodenectomy (PD). Methods Patients matched inclusion and exclusion standards were divided into two groups. The patients after PD before the implementation of ERAS programme were named as the control group (40 cases). The patients after PD with the implementation of ERAS programme were named as the experimental group (52 cases). The fast blood glucose (FBG) in postoperative day (POD) 1, 3, 7 and the volatility of capillary blood glucose during postoperative 3 days were compared between the two groups. Results The FBG in POD1, POD3, POD7 were (8.27 ± 1.99), (6.78 ± 1.22), (5.97 ± 1.21) mmol/L in the experimental group respectively, and the FBG in POD1, POD3, POD7 were (10.46 ± 5.17), (7.88 ± 2.98), (7.29 ± 2.94) mmol/L in the control group respectively, there were significant differences between two groups (t=2.545, 2.219, 2.683, all P<0.05). The volatility of capillary blood glucose during postoperative 3 days in the experimental group were (3.47± 1.98), (3.16 ± 1.46), (2.74 ± 1.49) mmol/L respectively, and the volatility of capillary blood glucose during postoperative 3 days in the control group were (4.13±2.36), (3.26±1.59), (4.07±2.74) mmol/L respectively, no significant differences were found in the volatility of capillary blood glucose in POD1 and POD2 between the two groups (t=1.479, 0.308, all P > 0.05), while significant differences were found in the volatility of capillary blood glucose in POD3 between the two groups (t=2.739, P<0.05). Conclusions It can be concluded that ERAS may be useful to decrease stress hyperglycemia and the volatility of capillary blood glucosein patients after PD, and accelerate the recovery of patients after PD.

Objective To study the effective surgical methods for the sequela of deep vein thrombosis(DVT) of lower extremity . Methods The clinical data of 32 patients with the sequela of DVT of lower extremity in 36 limbs treated by surgery since 1992 were analysed retrospectively. Results Diagnosis accuracy rate of angiography in sequela of DVT was 100%. There were type I in 5 limbs, type IIA in 4, type IIB in 12,and type III in 15. External constriction valvuloplasty of superficial fomoral vein(SFV) was performed on 16 limbs,valvuloplaasly of SFV on 3 limbs,great saphenous vein popliteal vein anastomosis in situ in 6 limbs,muscular loop plasty on popliteal vein in 4 limbs,common iliac vein SFV anastomosis with artificial vessel interposition in 3 limbs,great saphenoas vien ansatomosed to opposite SFV in 4 limbs. After treatment,symptoms totally disappeared in 28 limbs ( 77.8% ), and improved in 8 limbs. Conclusions The vasography is diagnostic chrysindicatrix of the DVT sequela. Different operations based on the damage of valves should be chosen.

Objective This study was performed to explore the use of intramuscular low-dose Zoletil(1.5 mg/kg)combined with isoflurane inhalation for tracheal intubation in miniature pigs while preserving spontaneous respiration by determining the 50％and 95％minimum alveolar concentrations effective inhaled(MAC EI50 and MAC EI95).The goal was to establish a safe anesthetic method for tracheal intubation in miniature pigs in which intubation is difficult.Methods Forty-four Bama miniature pigs underwent general anesthesia.Following sedation with an intramuscular injection of sufentanil,anesthetic induction was performed using mask inhalation of isoflurane with monitoring of the heart rate,blood pressure,respiration,body temperature,oxygen saturation,end-tidal carbon dioxide concentration,and end-tidal isoflurane concentration.The initial end-tidal isoflurane concentration was set at 2.0％.The tracheal intubation conditions and outcomes were evaluated using Cooper's scoring system,and the dose-response relationship was calculated using Dixon's up-and-down method.Probit regression was employed to calculate the MAC EI50 and MAC EI95 along with their 95％confidence intervals(CI).Results In tracheal intubation using direct laryngoscopy with induction by low-dose sufentanil combined with isoflurane inhalation in miniature pigs,the MAC EI50 was 3.10％(95％CI,2.79％～3.56％)and the MAC EI95 was 3.77％(95％CI,3.41％～6.42％).With proper monitoring and airway management planning in place,alveolar isoflurane concentrations ranging from 3.10％to 3.75％were able to maintain stable vital signs in the miniature pigs.Conclusions The use of Zoletil combined with isoflurane inhalation for tracheal intubation in miniature pigs,aimed at preserving spontaneous breathing,is a preferable and safe anesthetic method for oral airway management in miniature pigs with significant potential for widespread application.

Objective To understand the bioinformatics of human ribosomal protein L22(RPL22)gene,prokary-otic expression and purification of human RPL22 recombinant protein,synthesis of human RPL22(labeled as agent M)in vitro,study the effects of agent M on proliferation,cycle and apoptosis of NSCLC A549 cells,and to analyze the effect of combination chemotherapy with M and cisplatin(DDP).Methods RPL22 bioinformatics was ana-lyzed.RPL22 gene was cloned by PCR,the single chain oligonucleotide was designed and synthesized to obtain the target gene,and connect the pET-28α vector.The pET-28α-RPL22 recombinant plasmid was constructed,and the receptive cell DH5α of Escherichia coli was transformed.The expression of recombinant protein RPL22 was analyzed by SDS-PAGE and Western blot.The semi-inhibitory rate(IC50)of M and DDP in A549 cells and the effect of M on the proliferation of A549 cells were detected by CCK-8.The effect of agent M on apoptosis and cycle of A549 cells was detected by flow cytometry.qPCR and Western blot assays were used to detect M and DDP on phosphati-dylinositol-3-kinase/protein kinase B(PI3K/AKT)and adenosine 5'-monophosphate activation of protein kinase/mammalian target of rapamycin(AMPK/mTOR)signaling pathway,respectively.Results RPL22 protein was an unstable and hydrophilic protein.The recombinant protein was dissolved and purified to obtain high concentration of recombinant protein.In A549 cells,the IC50 of reagent M was 400 μg/L,and the IC50 of DDP was 10 μmol/L,and the concentration of reagent M was inversely proportional to the cell activity.The inhibitory effect of reagent M(200 μg/L)combined with DDP(2.5 μmol/L)was similar to that of DDP(10 μmol/L)alone.Reagent M could induce G2 cell cycle arrest and promote apoptosis,and might be involved in the regulation of PI3 K/AKT and AMPK/mTOR pathways.Conclusion The recombinant RPL22 protein is cloned and expressed successfully.

Objective:To explore the key points of the pathological and differential diagnoses of extra-medullary masses of hematopoietic cell tumors of ambiguous lineage, and to discuss the possible solutions.Methods:Five hematopoietic cell tumors of ambiguous lineage cases were collected, including myeloid sarcoma, mixed phenotype acute leukemia, B/myeloid, T-lymphoblastic lymphoma combined with acute myeloid leukemia, acute undifferentiated leukemia with cutaneous MPDCP and early T-precursor cell acute lymphoblastic leukemia. The data including morphology, immunostaining, and flow cytometry analysis were collected, and we explored the problems and differential diagnosis in the diagnosis of hematopoietic cell tumors of ambiguous lineage.Results:The five cases showed that the accurate pathological diagnosis and classification of hematopoietic cell tumors of ambiguous lineage should be based on lineage-specific antigens. Moreover, tumor cells have the potential of multi-directional differentiation. In different sites or different periods, the differentiation of tumor cells may be different. Biopsy and detection of all related markers should be performed for the initial diagnosis, and the detection should be repeated when the condition of the patient changes. Combined application of multi-techniques, including morphology and flow cytometry analysis, is recommend for the diagnosis of hematopoietic cell tumors of ambiguous lineage, since the conventional morphology and immunophenotyping methods are limited.Conclusion:Hematopoietic cell tumors of ambiguous lineage are derived from hematopoietic stem cells with a potential of multi-differentiation. The differentiation of tumor cells is variable. We need to integrate cell morphology, flow cytometry, pathology, clinical data, and molecular genetics to make a comprehensive diagnosis.

Objective:To explore the association between postoperative radiotherapy for bladder cancer and the risk of second primary rectal cancer.Methods:Eligible 75 120 patients with bladder cancer from the Surveillance, Epidemiology, and End Result database (SEER) of the National Cancer Institute (NCI) (1975-2017) were enrolled in this study. The second primary cancers referred to rectal cancers patients suffered after more than five years post-treatment for bladder cancer, and the cumulative incidence was estimated using Fine-Gray competing risk regression. The relative risk (RR) of rectal cancer in patients treated with or without radiotherapy (the RT group or the NRT group) was evaluated using Poisson regression.Results:Among the 75 120 patients, 70 045 (92.4%) were Caucasian, with a median age of 65.8 years (54-74 years). A total of 2 236 (3%) received postoperative radiotherapy, while 72 884 (97%) received surgery alone. The 30-year follow-up revealed a cumulative incidence of rectal cancer of 0.93% in the RT group and 0.43% in the NRT group ( P = 0.004). The competing risk regression analysis identified a significant association between radiotherapy and rectal cancer ( HR: 1.86; 95% CI 1.26-2.74, P < 0.009). Furthermore, the RR of radiotherapy-associated rectal cancer significantly increased as the diagnosis occurred earlier (1975-1985 vs. 1985-1994: RR 2.59; 95% CI 1.20-4.86, P < 0.001), and a lower age at the time of radiotherapy was associated with a higher probability of second primary tumors (≤50-year old vs. > 50 year old : RR 7.89, 95% CI 2.97-21.30, P < 0.001). As calculated using the Poisson distribution, the RR of second rectal tumors was higher in the RT group ( RR: 2.20, 95% CI 1.45-3.18, P < 0.001), even after adjusting the date of diagnosis ( RR: 1.77, 95% CI 1.17-2.57, P = 0.009). Conclusions:An increased risk of rectal cancer following bladder cancer radiotherapy necessitates aggressive follow-ups for the purpose of early detecting second primary rectal cancer associated with bladder cancer radiotherapy.

Cassiae Semen is a substance with both edible and medicinal uses approved by the National Health Administration， and it is widely used in health food products in China. In this study， an information database of Cassiae Semen-based health food products was constructed， and the common patterns of functional claims， major raw materials， and dosage forms were analyzed. The Apriori algorithm and network method were used to analyze the association rules of high-frequency ingredients with the three major functional claims： Maintaining blood lipid （cholesterol/triglyceride） level， controlling fat， and relaxing bowel. Secondly， based on the positioning and regulatory requirements of health food and the recent research progress in Cassiae Semen， this paper analyzed the problems in technology review and product development from safety， function claim， and quality controllability. Finally， suggestions were put forward to promote the inheritance and carry forward China's traditional healthcare culture and the achievement of the Healthy China Initiative. These suggestions included classifying and optimizing the access management of health food， innovating the traditional healthcare function claims， and strengthening the quality system construction and information disclosure of post-marketing evaluation.

In response to the Opinions of the CPC Central Committee and the State Council on Promoting the Inheritance， Innovation， and Development of traditional Chinese medicine（TCM） and the spirit of the National Conference on TCM， Chinese Association of Chinese Medicine organized experts in Otorhinolaryngology Head and Neck Surgery of traditional Chinese and western medicine to discuss the clinical advantages of TCM and integrated traditional Chinese and western medicine in the treatment of allergic rhinitis （AR） and they reached a basic consensus. In recent years， the prevalence of AR has been on the rise， threatening the quality of life of patients and giving rise to a heavy burden to both the patients and the society. AR is resulted from immune imbalance rather than reduced immunity or hyperimmunity， and the imbalance is similar to the Yin-yang disharmony in TCM. In the treatment of this disease， western medicine features rapid onset. However， it is cost-intensive and causes severe surgical trauma， and the recurrence is common. TCM boasts diverse methods for AR， which can be used in all stages of this disease. It has advantages in controlling symptoms such as nasal congestion， runny nose， or dysosmia in the attack stage， preventing recurrence in the remission stage， and treating refractory AR or steroid-resistant AR. In particular， acupuncture enjoys a reputation in treatment of AR， which has been supported by evidence-based medicine and recommended by guidelines. While treating local symptoms of AR， TCM regulates the psychosomatic conditions， which facilitates chronic disease management and long-term follow-up. We should integrate the advantages of TCM and western medicine， give full play to the unique nonnegligible and irreplaceable advantages of TCM， formulate a comprehensive diagnosis and treatment scheme for learning and promotion， and summarize the research outcomes to promote the theoretical innovation of TCM on AR from the perspective of integrated traditional Chinese and western medicine.