With the increasing detection rate of early upper gastric cancer and adenocarcinoma of esophagogastric junction, the safety of proximal gastrectomy with clear indications has been verified, and function-preserving proximal gastrectomy has been widely used. However, proximal gastrectomy destructs the normal anatomical structure of esophagogastric junction, resulting in severe postoperative gastroesophageal reflux symptoms and seriously affecting the quality of life. Among various anti-reflux surgery methods, reconstruction of "cardiac valve" has always been the focus of relevant scholars because its similarity with the mechanism of normal anti-reflux. After years of development, evolution and optimization, the designed seromuscular flap anastomosis includes tunnel muscle flap anastomosis, Hatafuku valvuloplasty, single muscle flap anastomosis and double muscle flap anastomosis. The double muscle flap anastomosis has become a research hotspot because it shows good anti-reflux effect in clinical application. This paper reviews the history, research status and hot issues of seromuscular flap anastomosis of esophageal remnant stomach at home and abroad.
Anastomosis, Surgical/methods* ; Esophagogastric Junction/surgery* ; Gastrectomy/methods* ; Gastroesophageal Reflux/surgery* ; Humans ; Quality of Life ; Stomach Neoplasms/surgery*

The quality control and standardization of procedures in radical gastrectomy for gastric cancer, especially the standardized processing of specimens after radical gastrectomy for gastric cancer, is very important. It is not only the basis of accurate pathological staging, but also the evidence of surgical quality and the original data of clinical research, which plays a pivotal role. The examination and classification of lymph nodes, specimens processing records, and data uploading and archiving after radical gastrectomy for gastric cancer are indispensable. It is necessary for surgeons to participate in the processing of surgical specimens. This article will combine the current research status and progress at home and abroad to review the standardized processing of specimens after radical gastrectomy for gastric cancer.
Gastrectomy ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Neoplasm Staging ; Stomach Neoplasms/surgery*

Objective: To study the efficacy and safety of laparoscopy and open choledochal exploration in the treatment of complicated hepatolithiasis. Methods: From March 2014 to March 2017, 150 cases of complicated hepatolithiasis who were treated in Heji Hospital Affiliated to Changzhi Medical College were selected.The patients were divided into observation group and control group according to random number table, with 75 cases in each group.The control group was treated with conventional open abdominal common bile duct exploration, and the observation group was treated by laparoscopic choledochal exploration.The levels of surgical indicators, the incidence of complications, the recurrence rate, the bilirubin level before operation and 1 month after operation, and the quality of life before operation and 6 months after operation were compared between the two groups. Results: The operative time, intraoperative blood loss, gastrointestinal recovery time and hospitalization time in the observation group were (154.23±20.47)min, (59.12±8.92)mL, (19.65±3.48)h, (11.48±2.48)d, respectively, which were significantly lower than those in the control group [(217.59±30.59)min, (87.24±10.17)mL, (27.87±6.12)h, (16.51±4.28)d] (t=14.908, 18.002, 10.112, 8.806, all P<0.05). The levels of total bilirubin, direct bilirubin and indirect bilirubin in the observation group at 1 month after operation were (14.38±3.69)μmol/L, (3.39±1.17)μmol/L, (11.45±3.02)μmol/L, which were significantly lower than those in the control group [(28.43±4.31)μmol/L, (6.31±2.08)μmol/L, (21.05±4.87)μmol/L] (t=21.445, 10.596, 14.508, all P<0.05). The incidence rate of complications and recurrence rate of the observation group at 6 months after operation were 2.67% and 0.00%, respectively, which were lower than 14.67% and 10.67% of the control group (χ²=6.822, 8.451, all P<0.05). The scores of social activities, energy, physical activity and sleep mood in the observation group at 6 months after operation were (4.72±0.85)points, (13.25±1.21)points, (3.81±0.51)points, (6.52±2.44)points, respectively, which were higher than those in the control group [(2.65±0.61)points, (8.09±0.68)points, (1.95±0.52)points, (3.98±2.38)points] (t=10.513, 11.605, 12.604, 6.454, all P<0.05). Conclusion Laparoscopic choledochal exploration is effective in the treatment of complicated hepatolithiasis, and it can improve the level of bilirubin and improve the quality of life, the safety is good.

In recent years, the incidence of adenocarcinoma of esophagogastric junction (AEG) keeps increasing. Siewert type II and type III AEG invades at 2-4 cm in the lower esophagus, and it has a higher rate of lower mediastinal lymph node metastasis. Lower mediastinal lymph node clearing through the abdomino-transhiatal (TH) approach is preferred, which can be accomplished by entering the lower mediastinum through the hiatus and mobilize the esophagus upward and the surrounding lymph and connective tissue for approximately 6.5 cm. Using the infracardiac bursa (IBC) as an anatomical landmark improves the safety and operability of the thorough dissection of the lower mediastinum. Total resection of the mesenterium at the esophagogastric junction can entirely dissect the lower mediastinal lymph nodes, which conforms to the safety principles in oncology.

italic>Sophora flavescens is a traditional Chinese medicine rich in flavonoids and has wide application potential in drug development and clinical practice. In this study, a total of 227 flavonoids were detected among five tissues of S. flavescens during anthesis using widely targeted metabolomics techniques. There were 137 flavonoids shared by five S. flavescens tissues and 18 root-specific flavonoids. There were 156, 155, 156 and 150 differentially accumulated metabolites identified in stem, leaf, flower, and young pod, respectively, compared with root. Forty-seven potentially active flavonoid components in S. flavescens were identified using the PubChem and SwissADME databases. The 58 potential target proteins for these potentially active components were predicted to be important in the treatment of type 2 diabetes mellitus (T2DM) based on the SwissTargetPrediction and GeneCards database. These 58 target proteins were used to construct a protein-protein interaction network through the STRING database, from which we performed GO and KEGG functional enrichment analysis. The mechanisms by which S. flavescens flavonoids may be useful in the treatment of T2DM was further explored in a multi-level and systematic way based on a "component-target-pathway" network. Finally, ten key potentially effective components were identified and found to be mainly distributed in the roots, flowers, and pods, and their content varied significantly between tissues. The results predict that the key targets of S. flavescens flavonoids in the treatment of T2DM are AKT1, ESR1, EGFR, PIK3R1, TNF and PTGS2, and that they play a hypoglycemic role through the regulation of endocrine resistance, AGE-RAGE, the PI3K-Akt signaling pathway, EGFR tyrosine kinase inhibitor resistance and other signaling pathways. This analysis of the tissue distribution and network pharmacology of S. flavescens flavonoids provides a theoretical basis for further studies on S. flavescens metabolites, the rational development and utilization of the S. flavescens aboveground parts, and initiates a comprehensive exploration of the mechanisms by which S. flavescens can be used in the treatment of T2DM.

Objective To analyse the clinical effects on colon cancer with acute intestinal obstruction.Methods 56 patients with acute intestinal obstruction caused by colon cancer were studied retrospectively.The experience of diagnosis was summarized.Results 47 patients with acute intestinal obstruction caused by colon cancer received Stage Ⅰ tumor resection and the other 9 patients received different stages.54 patients healed (96.4％) and 1perioperative deaths (1.8 ％).Postoperative complications occurred in 18 cases (32.1％) including incision infection,intraperitoneal infection and intestinal fistula.Conclusion Stage Ⅰ tumor resection is feasible and safe surgical procedures for acute intestinal obstruction caused by colon cancer.

BACKGROUND:Calcitonin gene-related peptide has been confirmed to induce osteogenic differentiation, but whether it can induce the osteogenic differentiation of adipose-derived stem cells under three-dimensional culture to construct tissue-engineered bone is rarely reported.
OBJECTIVE:To investigate the feasibility of exogenous calcitonin gene-related peptide to induce osteogenic differentiation of adipose-derived stem cells combined with calcium alginate gel in three-dimensional condition.
METHODS:Adipose-derived stem cells were gained by col agenase I digestion of the subcutaneous adipose tissue of both inguinal regions of New Zealand rabbits. Passage 3 cells were mixed with sodium alginate to prepare calcium alginate gel, and then the cells were assigned into two groups and cultured in 24-wel plates. Adipose-derived stem cells in the control group were cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 supplemented with 10-2 mol/Lβ-glycerophosphate sodium, 10-7 mol/L dexamethasone, 50 mg/L ascorbic acid, 10%fetal bovine serum. While, adipose-derived stem cells in the experimental group were incubated with the same medium as above, but 1.5 μg/L calcitonin gene-related peptide was added. The cells proliferation and the mRNA expressions of col agen I and osteocalcin were detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and reverse transcription-PCR respectively, and alkaline phosphatase and calcium concentration were detected at different induction time.
RESULTS AND CONCLUSION:The cellproliferation curves were S shaped. The absorbance values of the experimental group were higher than those of the control group at1, 3, 5, 7, 14, 21 days after osteogenic induction (P<0.05). Alkaline phosphatase and alizarin red staining of adipose-derived stem cells was al positive, but golden round nodes became more and bigger in the experimental group compared with the control group after 2 weeks. At 7 and 14 days, col agen I and osteocalcin mRNA expressions were higher in the experimental group than in the control group. Alkaline phosphatase activity and calcium concentration of the experimental group were higher than those of the control group at 1, 2, 3, 4 weeks after osteogenic induction (P<0.05). Results showed that the calcitonin gene-related peptide can induce the osteogenic differentiation of adipose-derived stem cells combined with calcium alginate gel.

OBJECTIVETo investigate the changes of CD4T lymphocytes in peripheral blood of patients with follicular lymphoma and its clinical significance.

METHODSBlood samples were collected for detection of whole blood cells, including absolute monocyte count (AMC), absolute lymphocyte count (ALC), hemoglobin (Hb), platelet count (Plt). Age, sex, pathological grade, number of involved lymph nodes, bone marrow involvement (BMI), Ann Arbor stage, B symptoms, serum lactate dehydrogenase (LDH) and serum β-2 microglobulin (β2-MG) were recorded, the prognostic stratification was performed by using FLIPI and FLIPI-2. The T lymphocyte subsets were analyzed by flow cytometry, including the absolute number of CD4T lymphocytes (ACD4C) and the absolute number of CD8T lymphocytes (ACD8C).

RESULTSPatients were with higher Ann Arbor stage, Hb<120 g/L, LDH greater than the upper limit of normal, the number of lymph nodes were involved> 4, the bone marrow was involvement, β2-MG levels were high FLIPI score and FLIPI-2 score, AMC level was higher (P<0.05). There were no significant differences in ACD4C levels among different groups. Patients with AMC≥0.89×10/L showed a shorter progression-free survival (PFS) and a shorter overall survival time (OS) (P=0.010,0.002) as compared with patients with AMC<0.89×10/L. The patients with ACD4C>0.16×10/L had longer progression-free survival and overall survival time, as compared with patients with ACD4C ≤0.16×10/L (P=0.016,0.012). Low ACD4C and high AMC related with shorter PFS and OS (P=0.013, 0.020). Univariate Cox regression analysis showed that age (P=0.026), bone marrow involvement (P=0.017), elevated LDH (P=0.001), β2-MG (P=0.014), FLIPI and FLIP2 score (P= 0.004 and 0.000) related with a shorter PFS. Multivariable Cox regression analysis showed that Hb (P=0.015), elevated LDH (P=0.003), β2-MG (P=0.045), bone marrow involvement (P=0.016) and FLIPI-2 score(P=0.003) related with short OS. ACD4C ≤0.16×10/L was a factor influencing prognosis of FL patients (PFS and OS) (P<0.05).

CONCLUSIONSLow ACD4C levels relatees with poor prognosis of patients with FL, and the ACD4C levels may be an important predictor for FL disease and prognosis.

Despite the extremely high mortality and disability rates of intracerebral hemorrhage, there are currently no effective interventions to improve the outcomes. More and more research shows that statins may be a new method for treating intracerebral hemorrhage. However, there is still much controversy about the relationship between statins therapy and intracerebral hemorrhage. This article reviews the recent studies on the relationship between statins and intracerebral hemorrhage.

OBJECTIVE: To observe the clinical effect of acupuncture at sphenopalatine ganglion combined with conventional acupuncture for episodic cluster headache (CH). METHODS: One hundred and eighty patients with episodic CH were randomly divided into a combined group (60 cases, 3 cases dropped off)，an acupuncture group (60 cases, 2 cases dropped off) and a sphenopalatine ganglion group (60 cases, 2 cases dropped off and 1 case was removed). The patients in the acupuncture group were treated with conventional acupuncture at Touwei (ST 8), Yintang (GV 24⁺), Yangbai (GB 14), Hegu (LI 4), etc., once a day, 6 times a week. The patients in the sphenopalatine ganglion group were treated with acupuncture at sphenopalatine ganglion, once every other day, 3 times a week. On the basis of the conventional acupuncture, the combined group was treated with acupuncture at sphenopalatine ganglion once every other day. Two weeks were taken as a course of treatment, and 3 courses of treatment were required in the 3 groups. The score of visual analogue scale (VAS), the number of headache attacks per week, the duration of each headache attack and the score of migraine-specific quality of life questionnaire version 2.1 (MSQ) were observed before and after treatment and in follow-up of 3 months after treatment. The clinical efficacy of each group was compared. RESULTS: After treatment and in follow-up, the VAS score of headache, the number of headache attacks per week, the duration of each headache attack, and each various scores and the total score of MSQ of each group were lower than those before treatment (P<0.01). Except that the number of headache attacks per week in the combined group was lower than the sphenopalatine ganglion group (P<0.01), other indexes in the combined group were lower than the other two groups (P<0.05, P<0.01). The total effective rate in the combined group was 93.0% (53/57), which was higher than 75.9% (44/58) in the acupuncture group and 73.7% (42/57) in the sphenopalatine ganglion group（P<0.05, P<0.01). CONCLUSION Acupuncture at sphenopalatine ganglion combined with conventional acupuncture could reduce the degree of pain in patients with episodic CH, reduce the number and duration of headache attacks, and improve the quality of life of patients. It is more effective than simple conventional acupuncture or acupuncture at sphenopalatine ganglion alone.
Acupuncture Points ; Acupuncture Therapy ; Cluster Headache/therapy* ; Headache/therapy* ; Humans ; Quality of Life ; Treatment Outcome