Objective To sum up clinical experience on subfascial endoscopic perforator surgery (SEPS) for the treatment of severe chronic venous insufficiency (CVI) of the lower extremities. Methods Fifty-one patients (64 limbs) with severe CVI received SEPS from Nov. 1999 to Aug.2002. CEAP classification, scoring of venous dysfunction (SVD), Color Doppler, Color Doppler velocity profile (CDVP), venography and air plethysmography (APG) were applied to assess the status of the affected limbs before and after operation. Results The postoperative follow-up was made from 3 to 35 months with the follow-up rate of 90.6% (58/64 limbs). No limbs suffered from recurrent superficial varicose. Venous ulcer was healed in 40 limbs (97.6%) and the ulcer ameliorated significantly in one limb. Ulcer healing time ranged from 9 to 91 days with the average time of (32?5) days. The average SVD was (13.9?1.7) preoperatively , while (6.4?0.8)postoperatively ( P

ObjectiveTo study the effect of apoptosis in the p athogenesis of great saphenous varicose(GSV) resulting from primary deep ven ous insufficiency (PDVI). Methods Apoptosis and Bcl-2 expres sion in the segment of first valve sinus of the GSV of PDVI of lower limbs w ere detected by transmission electron microscopy(TEM), agarose gel electrophore sis, TUNEL and immunohistochemistry. ResultsThere were 38 case s of PDVLs in experment group and 5 normal GSV in control group. In experiment group,the apoptosis cells(AC) (6.30? 2.70 )and apoptosis rate (AR)(0.42?2 .12) in the first valve sinus of GSV were significantly higher than those in control group(1.60?0.81,0.21?1.10,respectively)(all P

Objective To explore the application value of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy.Methods The clinical data of 15 patients who underwent laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique at the First People's hospital of Foshan between August 2012 and May 2014 were retrospectively analyzed.The hilar plate was bluntly dissected to expose the left and right Glissonean pedicles.Either side of Glissonean pedicle was tied up with a turnable aspirator with a cotton rope or shoelace and then bypassed the back of hilar plate.Anatomic hepatectomy was performed when hemi-hepatic blood flow was occluded.The follow-up by telephone interview and outpatient examination was done till October 2014.Results Among the 15 patients,the conversion to open surgery was done in 1 patient,Pringle maneuver in 1 patient,and hemi-hepatic blood flow occlusion by descending the hilar plate in 14 patients.Thirteen patients received succesfully laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique,including 4 of left hemihepatectomy,4 of left lateral lobectomy,2 of right hemihepatectomy,1 of right posterior lobectomy,1 of segment Ⅳ hepatectomy and 1 of segment Ⅵ hepatectomy.Bile duct exploration was applied to 4 patients with left hepatic duct stones and T-tube was placed in 2 patients.Nine and 4 patients received left and right hemi-hepatic blood flow occlusion,respectively.The operation time,mean volume of intraoperative blood loss and time of hemi-hepatic blood flow occlusion in 13 patients were (196 ±63)minutes,320 mL (range,50-1 200 mL) and (51 ± 20)minutes,respectively.The time of descending the hilar plate in 14 patients was (10 ±4)minutes.Among the 13 patients,bile leakage was detected in 1 patient with a maximum volume of drainage of 120 mL/day,liver wound bleeding in 1 patient with a volume of abdominal bloodstained drainage of 400 mL at postoperative day 2.Two patients were cured by conservative treatment,and no liver failure and perioperative death were occurred.The duration of hospital stay was (6.9 ± 2.4)days.Among the 15 patients,2 patients were loss to follow-up and other patients were followed up for 5-26 months with good survival,1 patient died.Conclusion Hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy is safe and feasible.

Objective To study the clinical efficacy of recombinant human epidermal growth factor (rhEGF) in the treatment of sacrococcygeal decubitus ulcers grade Ⅲ with direct polymerizing suture after appling rhEGF to reinforce wound bed preparation (WBP). Methods From January 2007 to October 2009, 60 patients with sacrococcygeal decubitus ulcers Grade Ⅲ, were divided into control group and treatment group. The ulcer size was 3 cm × 4 cm to 10 cm × 12 cm and all ulcers were infected for 15-70 d. Treatment group received traditional dressing change and appling rhEGF to reinforce wound bed preparation. Control group received traditional dressing change only. The operative technique that we used in two groups was direct polymerizing suture. Cure rate of stage Ⅰ and complication morbidities were analyzed. Results Cure rate of stage Ⅰ was 87% in treatment group and 70% in control group. Complication morbidities were 13% in treatment group and 30% in control group. The difference between these two groups was statistically significant (P ＜ 0.05). Conclusion Appling rhEGF to reinforce wound bed preparation before operation could make subsequent treatment more effective and improve the cure ratio of operation with decreasing complications and morbidities. And more, dissecting under fascia possesses the advantages of easiness to perform and rich blood supply.The method of appling rhEGF with direct polymerizing suture is a simple, high efficient approach for the first repairment of sacrococcygeal decubitus ulcers grade Ⅲ, especially desirable for the elderly.

Objective To investigate the safety and feasibility of modified hand-assisted laparoscopic surgery (MHALS) in the abdominal surgery.Methods The clinical data of 8 patients who underwent long-sleeved MHALS at the First People's Hospital of Foshan between September 2014 and January 2015 were retrospectively analyzed.Among the 8 patients,right liver cancer with intrahepatic metastasis was found in 2 patients,left liver cancer in 1 patient,hepatic peripheral nerve sheath tumor in 1 patient,left retroperitoneal leiomyosarcoma in 1 patient,extra-and intra-hepatic cholangiolithiasis in 1 patient,choledochocyst in 1 patient and ampulla cancer in 1 patient.Laparoscopic protection sleeve went through the middle of incision-retractor,and then wrapped around it about 10 cm.Incision-retractor was fixed at the abdominal incision firstly,laparoscopic procedures were performed when the wrist of assisted hand was bound and fixed by the distal of sleeve.The patients were followed up by outpatient examination and telephone interview till March 2015.Results All the 8 patients underwent successful MHALS,including 1 of right hemihepatectomy in situ,1 of ligation of right portal vein + left liver split (the patient gave up two-stage operation due to intractable ascites and elevated bilirubin),1 of hepatic left lateral lobectomy (the patient underwent hemostatic sutures in open surgery due to hemorrhage of liver's cutting surface),1 of hepatic peripheral nerve sheath tumor resection,1 of left retroperitoneal leiomyosarcoma resection,1 of choledocholithotomy + left hepatectomy + cholecystectomy + T tube drainage,1 of choledochocyst + biliary enteric drainage and 1 of pancreaticoduodenectomy.Four patients had assisted incision of 4 cm,and another 4 patients of 7 cm.Eight patients were followed up for a median time of 3 months (range,2-7 months).The patient who received ligation of right portal vein + left liver split died at postoperative month 3,and the others didn't have recurrence of tumor or lithiasis.Conclusion The MHALS is safe and feasible in the abdominal surgery.

Objective To investigate the application value of continuous irrigation and vacuum suction by subcutaneous drainage tube for prevention of abdominal type Ⅳ incision infection.Methods A prospective,single-blind, randomized, controlled study was conducted based on the clinical data of 123 patients with abdominal type Ⅳ incision infection who were admitted to the First People's Hospital of Foshan between January 2008 and July 2014.Patients were divided into the experimental group and the control group based on the random number table and received open surgery.Patients in the experimental group were placed subcutaneous drainage tube with postoperative continuous irrigation and vacuum suction, while patients in the control group adopted the method of traditional abdominal closure without subcutaneous drainage tube.The levels of preoperative hemoglobin (Hb) and albumin (Alb), severity grading according to the American Society of Anesthetheologists (ASA), levels of Hb and Alb at postoperative day 1, 3, 7 were recorded and postoperative incision infection and bacteria culture were observed.Patients received bi-weekly regular return visit by outpatient evamination after discharged up to 3 months after suture removal.Measurement data with normal distribution were presented as x-± s and comparison between groups was analyzed by t test.Measurement data with skew distribution were presented as M (Qn) and comparison between groups were analyzed by rank sum test.Repeated measures data were analyzed by the repeated measures ANOVA.Count data were analyzed by the chi-square test.Results One hundred and twenty-three patients were screened for eligibility, and 65 were allocated into the experimental group and 58 into the control group.The levels of Hb and Alb at postoperative day 1, 3, 7 were (111 ± 15) g/L, (107 ± 18) g/L, (108 ± 13) g/L and 30 g/L (26 g/L,32 g/L), 31 g/L(28 g/L,33 g/L), 35 g/L(32 g/L,37 g/L) in the experimental group and (112 ± 13)g/L, (106 ±16)g/L, (106 ± 12)g/L and 30 g/L(25 g/L,32 g/L), 32 g/L(29 g/L,33 g/L), 37 g/L (32 g/L,38 g/L) in the control group, with no significant difference in the changing trends of the above indexes between the 2 groups (F =0.124, 0.007, P ＞ 0.05).There were 4 patients with incision infection in the experimental group and 12 patients in the control group, showing a significant difference (x2=2.723, P ＜ 0.05).The infections occurred at postoperative 4-6 days confined to subcutaneous tissues and unreached to muscular and below layers, and then were cured by incision open drainage without recurrence.Patients without incision infection were removed the stitches at postoperative 7-9 days.Incision bacteria cultures showed that Escherichia coli was detected in 8 cases (including 1 complicated with Enterococcus faecalis and 1 complicated with Klebsiella pneumonia and Pseudomonas aeruginosa), Pseudomonas aeruginosa in 1 case, Klebsiella pneumonia in 2 cases, Acinetobacter baumanii in 1 case, Enterobacter cloacae in 1 case and no bacteria in 3 cases.All the patients were followed up for 3 months after incision healing and survived well without recurrence and complications such as incision split and incision fistula.Conclusion Continuous irrigation and vacuum suction by subcutaneous drainage tube can be operated easily and effectively reduce the postoperative infection rate in abdominal type Ⅳ incision.

Objective To establish a rapid and convenient method for determination of genomic DNA methylation in cells.Methods Five standard substances (dC, mdC, dA, dT and dG) were separated by high-performance capillary electrophoresis.Bare fused-silica capillary was used and eletrophoresis buffer was 48 mmol/L NaHCO3 with 60 mmol/L SDS, pH 9.6.The temperature of separation was controlled at 25 ℃ and a voltage of 20 kV was applied.The separation of the mixture was performed at a wavelength of 256 nm with UV-Vis detection and injection time was 5 seconds at 0.7 psi.Under optimal condition,genomic DNA methylation in methotrexate drug-resistant A549 cells was detected.Results The optimal condition was made by adjusting SDS concentration(40, 60, 80 mmol/L), pH value of running buffer(9.4,9.6, 9.8), voltage(15, 17, 19, 20, 22 kV), injection time(5, 10, 15, 20, 30 s) and capillary temperature(15, 20, 25, 30 ℃).The method for determination of genomic DNA methylation in cells was established.Five substances were completely separated by high-performance capillary electrophoresis in 10 mins.Intra-day coefficient of variation was less than 0.2% and inter-day coefficient of variation was less than 2%.The minimal detection limit was 2 μmol/L.Percentage of mdC in A549 parent cells was (4.80 ±0.52) %.Percentage of mdC in 15, 30, 40 μmol/L methotrexate drug-resistant A549 cells were (4.20±0.44) %, ( 3.70 ± 0.36 ) %, (3.10±0.35 ) %, respectively.Conclusions Genomic DNA methylation can be quantificated by high-performance capillary electrophoresis efficiently, rapidly, conveniently and sensitively.Genomic DNA methylation in methotrexate drug resistance cells decreases significantly.

Objective To evaluate the iodine nutritional status and thyroid function of pregnant women in different periods of pregnancy,analyze the relationship between iodine nutritional status and thyroid function and provide a basis for scientific supplementation of iodine to pregnant women.Methods In 2013 and 2014,using stratified random sampling method,six counties were selected in the city;around 30 early,middle and late pregnant women each in every county were selected;a total of 545 (173 early,203 middle and 169 late) pregnant women were investigated in the 6 counties;instant random urine samples of 25 ml were collected and urinary iodine was tested.A total of 151 (52 early,55 middle and 44 late) pregnant women were selected to collect 3 ml venous blood samples for determination of thyroid hormone and thyroid autoantibodies.Results Median urinary iodine levels of early,middle and late pregnant women were 132.2,128.9 and 113.5 μg/L,respectively,under the condition of iodine deficiency.Prevalence rates of low frce thyroxine FT4,subclinical hypothyroidism,hypothyroidism and hyperthyroidism in pregnant women were 0.66％ (1/151),15.23％ (23/151),0.66％ (1/151) and 0.66％ (1/151),respectively.The positive rate of TgAb and TPOAb was 15.23％ (23/151) and 11.92％ (18/151),respectively.There were significant differences in the levels of free three iodine thyroid (FT3) in different periods of pregnancy (F =7.723,P ＜ 0.05);FT3 in late pregnancy was lower than that in early and middle pregnancy (P ＜ 0.05).There were significant differences in the levels of FT4 in different periods of pregnancy (F =3.762,P ＜ 0.05);FT4 in late pregnancy was lower than that in early and middle pregnancy (P ＜ 0.05).There were significant differences in the levels of thyroid stimulating hormone (TSH) in different periods of pregnancy (F =13.199,P ＜ 0.05);TSH in early pregnancy was higher than that in middle and late pregnancy (P ＜ 0.05).Subclinical hypothyroidism prevalence rate in late pregnancy was higher than that in middle pregnancy (x2 =3.912,P ＜ 0.05).The positive rate of TgAb in early and middle pregnancy was higher than that in late pregnancy (x2 =9.883,3.906,all P ＜ 0.05).Urinary iodine ≥250 μg/L was a risk factor for subclinical hypothyroidism in pregnant woman [odds ratio (OR) =5.076,P ＜ 0.05].Conclusions The iodine nutrition of pregnant women in Tianjin is insufficient.Excessive urinary iodine is an increased risk of subclinical hypothyroidism.We should monitor the urinary iodine and thyroid function in pregnant women.

Objective:To investigate the effect of traditional Chinese medicine (TCM) icariin (ICA) on metastatic phenotype of methotrexate (MTX)-resistant lung cancer A549 cells and elucidate the action mechanism and therapeutic value of ICA. Methods:The half inhibition concentration(IC_(50))value of ICA in inhibiting the growth of A549/MTX cells was measured by MTT assay. The colony formation rates and the morphology of cell cluster of A549/MTX and ICA-treated A549/MTX cells were determined by double-layer soft agar colony formation assay. The migration abilities of A549/MTX and ICA-treated A549/MTX cells were evaluated by cell scratch assay. The invasion ability of cells was tested by using Transwell chamber assay. Results:MTT assay showed that the IC_(50) value of non-toxic ICA plus MTX was reduced compared with that induced by equal dose of MTX (35.50±1.85 μmol/L vs 52.17±2.25 μmol/L). The colony formation rate of ICA-treated A549/MTX cells was 0.94±0.09, less than that of A549/MTX cells (1.56±1.07, P<0.05). Cell scratching assay demonstrated that the migration capability of A549/MTX cells was stronger than that of ICA-treated A549/MTX cells at 72 h (P<0.05). Transwell experiment revealed that more A549/MTX cells passed through artificial basement membrane than ICA-treated A549/MTX cells (P<0.05), indicating that the invasion capability of ICA-treated A549/MTX cells was weaker than that of A549/MTX cells.Conclusion:TCM ICA can reverse the metastatic phenotype of MTX-resistant A549 cells.

Coronavirus disease 2019 (COVID-19) can cause great damage to the elderly patients and lead to high mortality. The clinical presentations and auxiliary examinations of the elderly patients with COVID-19 are atypical, due to the physiological ageing deterioration and basal pathological state. The treatment strategy for the elderly patients has its own characteristics and treatment protocol should be considered accordingly. To improve the diagnosis, treatment, and prevention of COVID-19 in the elderly, the Expert Committee of Geriatric Respiratory and Critical Care Medicine, China Society of Geriatrics established the "Expert consensus for the diagnosis, treatment, and prevention of coronavirus disease 2019 in the elderly" . We focused on the clinical characteristics and key points for better treatment and prevention of COVID-19 in the elderly. (1) For diagnosis, atypical clinical presentation of COVID-19 in the elderly should be emphasized, which may be complicated by underlying disease. (2) For treatment, strategy of multiple disciplinary team (mainly the respiratory and critical care medicine) should be adopted and multiple systemic functions should be considered. (3) For prevention, health care model about integrated management of acute and chronic diseases, in and out of hospital should be applied.