Objective To explore the relationship between phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt)/mammals target protein rapamycin (mTOR) signal transduction pathway and Barrett esophagus genesis.Methods A total of 140 rats were divided into sham operated group (n=10),iron group (n =10),esophageal duodenal side anastomosis group (n =30),esophageal duodenal side anastomosis plus iron group (n-30),esophageal gastric duodenal side anastomosis group (n=30) and esophageal gastric duodenal anastomosis plus iron group (n=30).In the end,10 normal esophagus tissue specimens,62 reflux esophagitis tissue specimens and 34 Barrett's esophagus tissue specimens were obtained.The expression levels of epidermal growth factor receptor (EGFR),Akt,phospho Akt (p-Akt),phospho-mTOR (p-mTOR) protein were detected by immunohistochemistry.Single factor analysis of variance,SNK between two groups and nonparametric correlation analysis were performed for statistical analysis.Results The protein expression levels of EGFR,Akt,p-Akt,p-mTOR in Barret(s esophagus tissues were higher than those in reflux esophagitis tissues and normal esophagus tissues (EGFR 0.1799±0.0367 vs 0.0438±0.0025 and 0.0277±0.0069,q=6.79,4.13; Akt 0.1874±0.0250 vs 0.0986±0.0093 and 0.0383±0.0048,q=6.51,3.56; p-Akt 0.1418±0.0130 vs 0.0592±0.0027 and 0.0281 ±0.0017,q=7.68,3.99; p-mTOR 0.1591±0.0275 vs 0.0674 ±0.0059 and 0.0112±0.0017,q=5.62,4.11; all P＜0.05).The protein expression levels of EGFR,Akt,p-Akt,and p-mTORin reflux esophagitis tissues were higher than those in normal esophagus tissues(q=4.67,4.29,4.27,4.03; all P＜0.05).Conclusion PI3K/Akt/mTOR signal transduction pathway were activated in reflux esophagitis and Barrett's esophagus,which provided theoretical basis for clinical multi-target treatment for diseases.

Objective To observe the effect of vibration therapy of Mongolian medicine on headache and vertigo in concussion patients.Method A hundred eligible subjects with concussion were randomized into a treatment group of 50 cases and a control group of 50 cases. The treatment group was intervened by brain vibration therapy of Mongolian medicine, while the control group was treated with Piracetam tablets. The scores of headache and vertigo in the two groups were observed before the treatment and respectively after 3-day, 6-day, and 9-day treatment. Result After 3-day, 6-day, and 9-day treatment, respectively, the scores of headache and vertigo were significantly different from those before the treatment in both groups (P<0.05). The scores of headache and vertigo respectively after 3-day, 6-day and 9-day treatment in the treatment group were significantly different from those in the control group (P<0.05). Conclusion The brain vibration therapy of Mongolian medicine is effective in treating headache and vertigo in concussion.

Objective To explore the clinical effect of three-dimensional (3D) and two-dimensional (2D) laparoscopic radical resection of colorectal cancer.Methods The retrospective cohort study was adopted.The clinical data of 83 patients who underwent laparoscopic radical resection of colorectal cancer at the People's Hospital of Zhengzhou University from March 2014 to November 2015 were collected.Forty-two patients undergoing 2D laparoscopic radical resection of colorectal cancer between March 2014 and December 2014 were allocated into the 2D group and 41 patients undergoing 3D laparoscopic radical resection of colorectal cancer between January 2015 and November 2015 were allocated into the 3D group.All the patients in the 2 groups underwent 2D or 3D laparoscopic radical resection of colorectal cancer based on the principles of lymph node dissection and tumor-free survival.Observation indicators included:(1) surgical situations:operation time,volume of intraoperative blood loss,number of lymph node dissected,(2) postoperative recovery:recovery time of gastrointestinal function,postoperative complications,duration of postoperative hospital stay,hospital expenses,(3) postoperative pathological situations:length of colorectal specimens,distance from tumor to distal incision margin,(4) follow-up.All the patients were followed up to detect postoperative survival,tumor metastasis and recurrence using outpatient examination and telephone interview up to March 2016.Measurement data with normal distribution were presented as x-± s and comparison between groups was analyzed using the t test.Count data were analyzed using chi-square test or Fisher exact probability.Results (1) Surgical situations:all the patients underwent successful laparoscopic radical resection of colorectal cancer,without conversion to open surgery and perioperative death.Operation time,volume of intraoperative blood loss and number of lymph node dissected were (171 ±18) minutes,(112±18)mL,14.0 ± 1.4 in the 2D group and (125 ± 13) minutes,(101 ± 16)mL,14.6 ± 0.9 in the 3D group,respectively,with statistically significant differences between the 2 groups (t =-13.091,-2.962,-3.623,P ＜0.05).(2) Postoperative recovery:recovery time of gastrointestinal function was (3.0 ± 0.6) days in the 2D group and (3.0 ± 0.6) days in the 3D group,respectively,with no statistically significant difference between the 2 groups (t =3.423,P ＞ 0.05).Incidence of postoperative complications in the 2D and 3D groups was 7.1％ (3/42) and 4.9％ (2/41),respectively,with no statistically significant difference between the 2 groups (P ＞0.05).One,1,1 patients in the 2D group were respectively complicated with anastomotic fistula,intra-abdominal hemorrhage and intra-abdominal infection,1 and 1 patients in the 3D group were respectively complicated with anastomotic fistula and intestinal paralysis,and they were improved by symptomatic treatment.Duration of postoperative hospital stay and hospital expenses was (10.0 ±0.8)days,(7.0 ± 1.4) × 104 yuan in the 2D group and (10.0 ±0.6)days,(7.3 ± 1.5) x 104 yuan in the 3D group,respectively,with no statistically significant difference between the 2 groups (t =15.716,0.941,P ＞ 0.05).(3)Postoperative pathological situations:length of colorectal specimens and distance from tumor to distal incision margin were (18 ± 7) cm,(4.7 ± 0.6) cm in the 2D group and (20 ± 8) cm,(4.9 ± 0.7)cm in the 3D group,respectively,with no statistically significant difference between the 2 groups (t =0.742,1.401,P ＞0.05).(4)Follow-up:of 83 patients,82 were followed up for 5-24 months with a median time of 12 months.During the follow-up,there was no occurrence of tumor-related death and recurrence and metastasis of sites of puncture.Intra-abdominal tumor recurrence,recurrence of anastomotic tumor and tumor distant metastasis were detected in 3,2,1 patients in the 2D group and 2,1,1 patients in the 3D group,with no statistically significant difference between the 2 groups (P ＞ 0.05).Conclusion Compared with 2D laparoscopic radical resection of colorectal cancer,3D laparoscopic radical resection of colorectal cancer is safe and feasible,and it can also reduce intraoperative blood loss and increase the rate of lymph node dissected,with a good short-term outcome.

BACKGROUND:With the development of surgical techniques and endovascular treatment techniques, the therapeutic efficacy on arteriosclerosis obliterans of the lower limbs has been improved greatly. As the long-term prognosis is stil not clear, how to treat arteriosclerosis obliterans of the lower limbs is stil a problem for vascular surgery. OBJECTIVE:To observe the long-term clinical efficacy of autologous bone marrow stem cel transplantation in the treatment of arteriosclerosis obliterans of the lower limbs. METHODS:Thirty-nine patients with arteriosclerosis obliterans who had undergone autologous bone marrow mesenchymal stem cels (totaly 56 times of cel transplantation) from September 2007 to July 2013 were enroled in this study. As of February 2015, the folow-up time was 7.5 years. After treatment, regular telephone folow-up about limb pain, cold sensation, intermittent claudication distance, resting ankle-brachial index and limb ulcer size and depth was done annualy; at 1 year after treatment, limb arteriography and venous blood gas analysis were reviewed. RESULTS AND CONCLUSION: Of the enroled 39 patients, 4 patients were subjected to amputation because of poor efficacy, 2 patients died of acute myocardial infarction, and 2 patients died of not timely amputation. There were 31 patients who had been folowed up for over 3 years. After treatment, the resting ankle-brachial index and limb ulcer size and depth limb pain were both improved significantly. There were significant differences in 1-year limb blood oxygen partial pressure and oxygen saturation before and after treatment, and the postoperative number of capilaries also increased significantly. These findings indicate that autologous bone marrow stem cel transplantation is a safe treatment for arteriosclerosis obliterans of the lower limbs with better and stable long-term curative effects. This method is a good choice for patients who have poor blood vessels and poor efficacy of traditional methods.

BACKGROUND:The assessment for long-term efficacy of chronic ischemic disease is more important than the short-term efficacy assessment, which associates with patient’s long-term quality of life and long-term survival rate. OBJECTIVE:To observe the 5-year folow-up outcomes of autologous bone marrow stem cel transplantation for the treatment of thromboangitis obliterans. METHODS:This study enroled 43 patients of thromboangitis obliterans who underwent autologous bone marrow stem cel transplantation from August 2007 to January 2010 in the Department of Thyroid Vascular Surgery, the First Affiliated Hospital of Xinjiang Medical University. At 1, 2, 3, 4 and 5 years after transplantation, pain, cold sensation, and intermittent claudication distance were folowed up by telephone; changes in limb ulcers were observed. At 1 year after transplantation, venous oxygen partial pressure and oxygen saturation of limbs were reviewed. RESULTS AND CONCLUSION:A total of 38 thromboangitis obliterans patients with complete folow-up data were included in the final analysis. Compared to the preoperation, pain, cold sensation, and intermittent claudication significantly improved. The difference was statisticaly significant (Z values:-4.277,-5.086,-3.574, P < 0.001). Compared with 1-5 years after operation, pain and cold sensation had no statisticaly difference (P >0.05). Intermittent claudication distance had increased. Differences in terms of intermittent claudication distance was statisticaly significant (Z=43.898,P < 0.001). Significant differences in venous oxygen partial pressure and oxygen saturation were detected between preoperation and 1-year posttransplantation (tvalues: 36.790, 43.964,P values: 0.040, 0.037). Above results suggest that autologous bone marrow stem cel transplantation for thromboangitis obliterans obtained stable long-term outcomes.

Objective To analyze the clinical features of Hashimoto thyroiditis with thyroid cancer, and provide scientific basis for clinical diagnosis and treatment. Methods The clinical data of 87 patients of Hashimoto thyroiditis with thyroid cancer and 105 patients of Hashimoto thyroiditis were retrospectively analyzed. Results The rates of Hashimoto thyroiditis with thyroid cancer in age <30, 30-39, 40-49, 50-59 and≥60 years were 1/3, 47.5%(29/61), 51.4%(38/74), 36.0%(18/50) and 1/4. The rates of Hashimoto thyroiditis with thyroid cancer in patients of age 30-39 years and 40-49 years were higher than that in patients of age ≥60 years, but there were no statistical differences (χ2=0.327 and 0.418, P>0.05). There were statistical differences in total thyroxine (TT4), thyroid stimulating hormone (TSH), thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) levels between Hashimoto thyroiditis with thyroid cancer and Hashimoto thyroiditis, there were statistical differences (P<0.05 or <0.01). Multiariable Logistic regression analysis result showed that the decreased serum level of TT4 and the increased levels of TSH, TgAb and TPOAb were the correlated factors of Hashimoto thyroiditis with thyroid cancer (P<0.05 or <0.01). Conclusions Low level of TT4 and high levels of TSH, TgAb and TPOAb may increase the risk of Hashimoto thyroiditis with thyroid cancer. The 30-49 years male patients with Hashimoto thyroiditis should be highly suspected of the possibility of merger thyroid cancer.

Objective To study the short-term curative effect of total parathyroidectomy (t-PTX) and cinacalcet therapy for treating refractory secondary hyperparathyroidism (SHPT).Methods The clinical data of 118 patients with refractory SHPT admitted in our hospital from January 2012 to September 2015 wereretrospectively analyzed,and according to different therapeutic methods the patients were divided into the group A (receiving the conventional medical treatment after poor effect by the impact therapy,n=62),B(performing t-PTX,n=26) and C (oral cinacalcet,n=30).All patients were given the conventional medical treatment.The calcium,phosphorus and calcium-phosphorus product,and parathyroid hormone (iPTH) follow-up on 0,1 d,and at 1,3,6 months was finished in 3 groups.Results The gender,age,dialysis time,calcium,phosphorus,calcium-phosphorus product and iPTH level on 1 d had no statistically significant difference among 3 groups(P＞0.05).the pain relief rates of the group A,B and C were 0,92.31 ％ and 60.00 ％ respectively;compared with the group A,phosphorus,calcium-phosphorus product and iPTH at various time points after processing in the group B and C were significantly decreased(P＜0.01);compared with the group C,calcium,phosphorus,calcium-phosphorus product and iPTH at various time points after processing in the group B were significantly reduced(P＜0.05).Conclusion If the patients with refractory SHPT are tolerable for surgery,t-PTX therapy should be taken as the first choice;oral cinacalcet treatment provides the possibility of non-operative therapy for the patients with refractory SHPT.

Objective To explore the clinical effect of three-dimensional (3D) laparoscopic radical gastrectomy of gastric cancer.Methods The retrospective cross-sectional study was conducted.The clinical data of 65 patients with gastric cancer who underwent 3D laparoscopic radical gastrectomy of gastric cancer in the People's Hospital of Zhengzhou University from January 2015 to July 2016 were collected.There were the same surgical procedure and postoperative treatment between 3D and two-dimensional (2D) laparoscopic radical gastrectomy of gastric cancer.Observation indicators:(1) surgical situations:operation time,volume of intraoperative blood loss,number of lymph node dissected;(2) postoperative recovery situations:time to anal exsufflation,time for semiliquid diet intake,duration of hospital stay,treatment expenses and postoperative complications;(3) postoperative pathological situations:pathological classification of gastric cancer,T stage,lymph node metastasis,TNM stage,surgical margin;(4) follow-up situations.The follow-up using outpatient examination and telephone interview was performed to detect patients' survival and tumor metastasis and recurrence up to July 2016.Measurement data with normal distribution were represented as x±s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical situations:all the 65 patients underwent successful 3D laparoscopic radical gastrectomy of gastric cancer and D2 lymph node dissection,without the occurrence of conversion to open surgery,intraoperative complications and perioperative death.Operation time,volume of intraoperative blood loss and number of lymph node dissected were (200± 55) minutes,(110± 80) mL and 32±7,respectively.(2) Postoperative recovery situations:time to anal exsufflation,time for semiliquid diet intake,duration of hospital stay and treatment expenses were (3.1 ± 1.0) days,(5.3 ± 1.6) days,(9.4± 3.0) days and (8.1 ± 1.3) × 104 yuan,respectively.Of 65 patients,5 had postoperative complications.One patient with anastomotic leakage underwent percutaneous endoscopic gastrostomy and abdominal drainage again and then was cured.One patient with peritoneal effusion and infection was cured after catheter drainage under CT guided.One patient with delayed gastric emptying was cured after symptomatic treatment.One patient with chylous fistula was cured after short-term fast and total parenteral nutrition treatment.One patient with pulmonary infection was cured after antibiotic therapy.(3) Postoperative pathological situations:① Pathological classification of gastric cancer:high-and moderate-differentiated adenocarcinoma was detected in 30 patients,poor-differentiated adenocarcinoma in 20 patients,signet ring cell carcinoma in 11 patients,mucinous adenocarcinoma in 3 patients and papillary adenocarcinoma in 1 patient.② T stage:27,15 and 23 patients were in T1,T2 and T3 stages.③ Twenty-five patients had lymph node metastases and 40 had no lymph node metastasis.④ TNM stage:19,17,15,12 and 2 patients were in Ⅰ A,Ⅰ B,Ⅱ,Ⅲ A and Ⅲ B,respectively.R0 resection was performed to all the 65 patients,with negative surgical margin under the microscope.(4) Follow-up situations:of 65 patients,61 were followed up for 3-18 months,with a median time of 9 months.During the follow-up,there was no occurrence of surgeryrelated complications,tumor metastasis and recurrence and death.Conclusion The 3D laparoscopic radical gastrectomy of gastric cancer is safe and feasible,with a good short-term outcome.

Objective To study the joint effect of small dosages of Aspirin and compound Danshen dropping pills on type 2 diabetes(T2DM) patients'and impaired glucose tolerance(IGT) patients' hypercoagulation blood.Methods The study followed diagnostic standards for T2DM by World Health Organization (WHO) in 1999,and randomly selected two groups of clinical patients:one had 63 patients with IGT and the other contained 68 patients with T2DM.Both groups took compound Danshen dropping pills with the total dosage of 10 pills each time,3 times per day,for continuum of 3 months.After that both groups stopped medication for 7 days,then began taking Aspirin after meal,with the dosage of 100 mg per day,for a continuum of 3 month.After that both groups stopped the medication for 7 days,then both group continued to take same dosage of ASA with addition of compound Danshen dropping pills of total amount of 10 pills per each time,3 times per day,for acontinuum of 3 months.Each medication period (ev ery 3 months) was monitored for platelet count (PET),prothrombin time (PT),kaolin partial thromboplastin time (APPT),The effective rate of anticoagulation for both groups were then calculated.Results The difference of PT、APTT between before and after taking single dosage of ASA for patients with impaired glucose tolerance (IGT) was statistically significant (P＜0.05),while patients with T2DM had no significant difference before and after taking same single dosage of ASA.Similarly, both groups with single dosage of compound Danshen dropping pills had no significant difference between before and after taking the medication.However,the difference of PT、APTT between before and after taking the combination of Aspirin and Danshen dropping pills of both groups were statistically significant (P＜0.05).IGT group with single dosage of ASA had an effective rate of 71.4％ for anti coagulation,while T2DM group with the same dosage reached 23.8％.The IGT group with combinatory dosage of ASA and Danshen dropping pills reached an effective rate of 100％ for anticoagulation,while T2DM group with the same dosage was 86.7％.The difference between those effective rates of anticoagulation was statistically significant in different medicine takeways of two groups (P＜0.05).Conclusion The combinatory use of small dosage of Aspirin with compound Danshen dropping pills had evident effect to improve IGT and hypercoagulation blood of T2DM patients who had good control of their blood glucose.

Refractory alopecia is one of the most intractable skin diseases.Through giving full play to the characteristics of holism and determination of treatment based on syndrome differentiation,basing on the whole,adjusting yin and yang,observing the pathogenesis in clinic and being well informed about the nomalities and changes of the disease,Professor BAI Chang-chuan has greatly broadened the clinical thinking and practice of TCM in treating alopecia.