Objective To explore the solid gastric emptying characteristics of awake gastroparesis Beagle. Methods A Beagle model of gastroparesis was established by truncal vagotomy combined injection glucagon. Solid gastric emptying of the Beagle under normal and gastroparesis were evaluated with ultrasound imaging,and compared with the results of radionuclide SPECT scintigraphy. Results The solid gastric emptying process of the Beagle was in accordance with modified power exponential models: Y =1-(1-e-kt)β, half time of the gastric emptying of gastroparesis Beagle was obviously longer than normal, there was a significant difference between the two situation ( P ＜ 0.05). Conclusions The solid gastric emptying characteristics of the gastroparesis Beagle has a stable mathematical expression.

Objective To validate the clinical performance of a domestic fibrinogen reagent by freezing method(Clauss method) on the coagulometer Japan Sysmex CA1500.Methods The domestic fibrinogen reagent as the reagent A and the Germany Siemens Dade thrombin reagent as the reagent D,the Clauss method was adopted to measure the within-run precision and between-run preci-sion in two levels of quality control respectively.The reference value range was verified by the reagent A in 165 cases of normal clin-ical samples.The fibrinogen detection results in 200 cases of clinical samples were compared between by the reagent A and the rea-gent D.The significance test and the equivalence test were performed.Results The within-run precision CV of the reagent A and D in two levels of quality control were 4.28%,6.98% and 3.45%,5.22% respectively,the between-run precision CV of the reagent A and D in two levels of quality control were 6.23%,10.34% and 6.20%,9.89% respectively,the differences had no statistical significance(P >0.05).The reference value range of the reagent A was 2.08 -3.92 g/L.The fibrinogen detection results of the clinical samples by the reagent A and D had the statistically significant differences (P =0.025).But the 90% bilateral confidence in-terval(90%CI :-0.09,0.15)of the difference in the mean detection results by these two reagents located in the equivalent interval (-0.27,0.27).Conclusion The domestic fibrinogen reagent for Clauss method has reliable detection results and is suitable for the coagulometer Japan Sysmex CA1500,which is equivalent to the clinical application of Germany Siemens Dade thrombin reagent.

Objective To prospectively compare the clinical effect of 131I therapy for Graves disease (GD) using the 131I-iodide dose determined by radioactive iodine uptake formula and by individualized experience method respectively.Methods (1) A total of 527 GD patients referred for 131I therapy were enrolled and divided into two groups using interval sampling method.Group 1 consisted of 241 patients with their 131I activity calculated by iodine uptake formula.Group 2 consisted of 286 patients with their 131I activity calculated by individualized method based on clinical experience.(2) The patients who were not cured for the first time were retreated after 3 months in the same way until remission.(3) All patients were followed for more than 1 year after GD was cured.The clinical outcome was compared between the 2 groups.x2 test and two-sample t test were used for data analysis.Results There were no significant differences in age,gender,disease course,ATD pretreatment,the time of ATD discontinuation,level of thyroid hormone and autoantibody before 131I therapy,131I uptake rate,size of thyroid and duration of follow-up between the two groups (t=0.156-1.430,x2 =0.159,all P＞0.05).Group 1 had less 131I dose than group 2 ((247.9± 107.3) MBq vs (329.3±177.6) MBq,t=6.102,P＜0.05),fewer patients whose disease was controlled at early stage (x2 =25.279,P＜0.05) and lower remission rate for the first time of treatment (x2 =13.074,P＜ 0.05),but higher repeated treatment rate (t =2.735,P＜0.05) and ratio of hypothyroidism to normalized patients at the first treatment (x2=10.190,P＜0.05).The number of patients with permanent hypothyroidism between the two groups had no statistically significant difference (x2=1.138,P＞0.05).Conclusions The first treatment dose of 131I by individualized experience method is slightly higher than that by radioactive iodine uptake formula.Individualized treatment method for GD based on experience might help to control the GD earlier and improve the one-off remission rate without increasing the rate of hypothyroidism.

Objective To investigate the operation process,extent of resection,protection function,the tumor recurrence and clicical value of neuronavigation with intraoperative ultrasound for treating functional glioma;signifi-cance of intraoperative ultrasound for correcting brain shift.Methods We analyzed the cliclical materical of 24 case of functional gliomas which were resected by neuronavigation with intraoperative ultrasound.Results The accuracy of localization of functional glioma was 100%.The distance of brain shift was 2 to 10mm,with an average 4.7mm.After 24 hours MRI confirmed that total removal of function glioma was achieved in 21 cases,subtotal in 3 cases.After oper-ation function improve was 20 cases,invalid of 2 cases,hemiplegia happened in 2 cases and no death in all the patients.Conclusion Neuronavigation with intraoperative ultrasound can correct brain shift and improve the accuracy of localization of functional glioma,to improve extent of function glioma and decrease dysfunction.Neuronavigation with intraoperative ultrasound is important to functional glioma.

Osteoporosis is a progressive metabolic disease. In traditional Chinese medicine (TCM), deficiency of the liver, spleen and kidney and blood stasis can induce osteoporosis. The main etiology was kidney deficiency which harmed the liver and spleen and causeqi-blood deficiency and blood stasis. The insufficiency of natural endowment and postnatal malnutrition caused poor nutrition of tendons and vessels, which induced debility of bone. This article discussed the etiology and pathogenesis of TCM understanding on osteoporosis in details. Opportunities and challenges of TCM in osteoporosis treatment were explored. The homology of Chinese medicine and food as well as the long-term of osteoporosis showed that TCM had incomparable superiority in osteoporosis treatment. While, the scientific research methods and reasonable evaluation of TCM safety were important to display its advantages in osteoporosis treatment.

UNLABELLEDOBJECTIVE To investigate an operative method of combined resection of preseptal fat: and partial retro-orbicularis oculus fat (ROOF) for correction of upper eyelid heaviness, and evaluate the efficacy and safety of the method.

METHODSPreseptal fat lies widely under the orbicularis oculi in the upper eyelid, and retro-orbicularis oculus fat (ROOF) lies in the lateral supraorbital area. Combined resection of preseptal fat and partial ROOF was performed in patients selected by examination. The efficacy and safety were evaluated by follow-up study.

RESULTSFrom May 2011 to July 2013, 38 selected patients received the treatment with 3 months to 28 months follow up. The heaviness of upper eyelid improved in all cases. One patient developed postoperative hematoma, and another patient had a transient numbness over the lateral upper brow region. 37 patients were satisfied with the result.

CONCLUSIONSCombined resection of preseptal fat and partial ROOF was effective in reducing the heaviness of upper eyelid, without major complications. The operative method should be an important adjunct for selected patients undergoing blepharoplasty.

Adipose Tissue ; surgery ; Blepharoplasty ; adverse effects ; methods ; Eyelids ; surgery ; Facial Muscles ; Follow-Up Studies ; Forehead ; Humans ; Safety

Objective To evaluate the influence of peritoneal lavage with different concentrations of povidone-iodine on hemodynamics and acid-base balance in rabbits.Methods Twenty-four clean-grade healthy adult male New Zealand white rabbits,aged 3 months,weighing 2.8-3.2 kg,were divided into 4 groups (n=6 each) using a random number table:control group (group C),povidone-iodine 1/3 of original concentration group (group TI),povidone-iodine l/2 of original concentration group (group HI) and povidone-iodine of original concentration group (group OI).Rabbits were anaesthetized with intraperitoneal 3％ pentobarbital 1.5 ml/kg,the left femoral artery was cannulated for invasive blood pressure monitoring,and the abdominal cavity was opened.Peritoneal lavage was performed with normal saline,povidone-iodine diluted with normal saline (1 ∶ 2),povidone-iodine diluted with normal saline (1 ∶ 1) and original povidone-iodine 20 ml at 10 min after opening abdominal cavity in C,TI,HI and OI groups,respectively.The fluid for peritoneal lavage was sucked out using a sterile gauze 2 min later and then the abdominal cavity was closed.Mean arterial pressure (MAP) and heart rate (HR) were recorded immediately before lavage (T0) and at 5,10 and 20 min and 1 and 2 h after the end of lavage (T1-5).Arterial blood samples were collected at T0,T4 and T5 for blood gas analysis,and the pH value,BE and lactic acid level were recorded.The duration of anesthesia before peritoneal lavage,cumulative dose of anesthetics,fluid volume and urine volume at 2 h after anesthesia,and mortality at 3 h after peritoneal lavage were recorded.Results Compared with group C,MAP at T1-5 and HR at T3-5 were significantly decreased in TI,HI and OI groups,pH value was significantly decreased and BE negative value was increased at T4,5 in HI and OI groups,the lactic acid level was significantly increased at T5 in group OI,and the mortality rate were significantly increased in HI and OI groups (P＜0.05).Compared with group TI,MAP at T4,5 and pH value at T5 were significantly decreased,BE negative value was increased at T5,and the lactic acid level was increased at T4,5 in group Ol (P＜0.05).There was no significant difference in each parameter between group OI and group HI (P＞0.05).Conclusion Peritoneal lavage with povidone-iodine dose-dependently leads to hemodynamic deterioration and acid-base imbalance in rabbits.

Objective To investigate the prognostic factors of transcatheter arterial chemoembolization (TACE) in the treatment of primary hepatocellular carcinoma (HCC).Methods A retrospective analysis was performed on 326 HCC patients treated with TACE.Kaplan-Meier method was used to calculate the 1-year,2-year and 3-year cumulative survival rates.Log-rank test and Cox proportional hazards model were used to analyze univariate and multivariate prognostic factors,respectively.Results The 1-year,2-year and 3-year cumulative survival rate of HCC patient was 73.90％,40.20％and 22.20％,respectively.The median survival time was 21 months.Univariate analysis showed that the alpha-fetoprotein (AFP),gamma-glutamyl transpeptidase (GGT),tumor size,tumor number,Child-Pugh grade,Barcelona clinic liver cancer (BCLC) stage,portal vein thrombosis,arteriovenous fistula and distant metastasis were factors affecting the prognosis of HCC patient (all P＜0.05).Multivariate COX regression analysis showed that AFP,GGT,tumor size,tumor number,BCLC stage,arteriovenous fistula were the independent prognostic factors of HCC patients (all P＜0.05).Conclusion AFP,GGT,tumor size,tumor number,BCLC stage and arteriovenous fistula are independent prognostic factors of HCC patients treated with TACE.

Objective: To analyze the impact of dual antiplatelet (DAPT) therapy combining with or without proton pump inhibitors (PPI) on the main outcomes after percutaneous coronary intervention (PCI). Methods: The PubMed, EMBASE and Cochrane Library were searched for relevant literature and the references obtained from these sources were retrieved manually from inception till September 2017. Inclusion and exclusion criteria were established follow the Cochrane review standard. A total of 977 literatures were included, 193 duplicates were excluded, 74 reviews, case reports, letters and systematic reviews were excluded, 667 literatures were excluded after reading the title and abstract, 34 literatures were excluded due to non-randomized control studies and unrelated outcome indicators, and 9 literatures were finally included with a total of 16 589 patients. RevMan 5.3 software was used to compare the incidence of major adverse cardiovascular events (MACE), cardiogenic death, recurrent myocardial infarction, target vessel revascularization, all-cause death, stent thrombosis, stroke, gastrointestinal bleeding and gastrointestinal events in patients with DAPT combining with or without PPI after PCI. Results: MACE was observed in 8 out of the 9 included literatures, and the results showed that MACE occurred in 561 out of 6 282 patients receiving DAPT combining with PPI therapy and in 951 out of 9 632 patients using DAPT alone (OR=1.15, 95%CI 0.88-1.51, P>0.05). Cardiogenic death was observed in 7 out of the 9 included literatures, and the results showed that cardiogenic death occurred in 172 out of 6 453 patients receiving DAPT combining with PPI treatment and in 321 out of the 9 839 patients using DAPT alone (OR=0.97, 95%CI 0.80-1.18, P>0.05). Recurrent myocardial infarction was observed in 7 out of the 9 included literatures, the results showed 416 out of 6 282 cases in DAPT combining with PPI therapy group experienced recurrent myocardial infarction and 691 out of 9 632 cases in DAPT group experienced recurrent myocardial infarction (OR=1.01, 95%CI 0.89-1.16, P>0.05). Four out of 9 literatures observed revascularization. The results showed that revascularization was performed in 64 out of 2 173 patients receiving DAPT combining with PPI therapy and in 105 out of the 2 770 patients using DAPT alone (OR=1.33, 95%CI 0.55-3.24, P>0.05). All-cause death was observed in 7 out of the 9 included literatures, and the results showed that all-cause death occurred in 172 out of the 6 453 patients in DAPT combining with PPI therapy group and in 321 out of the 9 839 patients using DAPT alone (OR=0.97, 95%CI 0.80-1.18, P>0.05). Three out of the 9 included articles observed stent thrombosis, and the results showed that stent thrombosis occurred in 99 out of 2 997 patients receiving DAPT combining with PPI therapy and in 245 out of the 6 198 patients treated with DAPT (OR=1.07, 95%CI 0.83-1.37, P>0.05). Stroke was observed in 2 out of the 9 included literatures. The results showed that stroke occurred in 5 out of 2 019 patients receiving DAPT combining with PPI therapy, and in 4 out of the 2 033 patients treated with DAPT (OR=1.00, 95%CI 0.29-3.49, P>0.05). Gastrointestinal bleeding was observed in 6 out of the 9 included literatures. The results showed that gastrointestinal bleeding occurred in 26 out of 3 517 patients receiving DAPT combined with PPI therapy, and in 93 out of the 3 506 patients treated with DAPT, gastrointestinal bleeding was significantly lower in the DAPT combining with PPI group than DAPT alone group (OR=0.27, 95%CI 0.17-0.41, P<0.01). Gastrointestinal events were reported in 6 out of the 9 included articles. Similarly, gastrointestinal events were observed in 51 out of 3 517 patients receiving DAPT combined with PPI therapy, and in 190 out of the 3 506 patients treated with DAPT alone, the incidence of gastrointestinal events in the DAPT combined with PPI group was significantly lower than DAPT alone group (OR=0.24, 95%CI 0.14-0.42, P<0.01). Conclusions The incidence of MACE, cardiogenic death, recurrent myocardial infarction, target vessel revascularization, all-cause death, stent thrombosis and stroke are not affected by DAPT combined with PPI therapy after PCI, while the incidence of gastrointestinal bleeding and gastrointestinal events could be reduced by adding PPI to DAPT in patients undergoing PCI.

Objective:To investigate the preventive effect of postoperative pancreatic fistula by pedicled omentum wrapping pancreaticojejunostomy in pancreaticoduodenectomy.Methods:The clinical data of 78 patients who underwent pancreaticoduodenectomy in Songjiang Hospital Affiliated to Shanghai Jiao Tong University from September 2017 to August 2020 were retrospectively analyzed. Patients were divided into the modified pancreaticojejunostomy group (conventional approach group, n=43) and the pedicled omentum wrapping pancreaticojejunostomy group (omentum wrapping group, n=35) according to the surgical mode. Postoperative pancreatic fistula, postoperative abdominal bleeding, delayed gastric emptying and postoperative hospital stay were compared between the two groups. Results:Compared with the conventional approach group, the postoperative pancreatic fistula rate in omentum wrapping group was significantly reduced (2.9% vs 18.6%), and the difference was statistically different ( P=0.030); postoperative abdominal bleeding rate(0 vs 4.7%)and the delayed gastric emptying rate were significantly reduced (8.6% vs 25.6%), but both of them were not statistically different ( all P value>0.05); the length of postoperative hospital stay was significantly reduced [(11.3±2.9) days vs (12.8±3.5)days], and the difference was statistically different ( P=0.045). Conclusions:The pedicled omentum wrapping pancreaticojejunostomy was simple and convenient, which can significantly reduce the rate of postoperative pancreatic fistula. It can shorten the time of the length of hospital stay after surgery.