ObjectiveTo observe the clinical efficacy and safety of Yuyin Lidan granules （YYLD） in preventing the recurrence of common bile duct stones （CBDS） in patients with liver and gallbladder dampness-heat syndrome following endoscopic retrograde cholangiopancreatography （ERCP）. MethodsThis randomized， parallel， controlled trial enrolled postoperative CBDS-ERCP patients who met the inclusion and exclusion criteria. Sixty-four patients were randomly assigned to an observation group or a control group， with 32 cases in each. Both groups received conventional Western medical treatment after ERCP， while the observation group additionally received YYLD for 8 weeks. The follow-up period lasted for 1 year. The efficacy indicators included bile bilirubin levels， traditional Chinese medicine （TCM） syndrome scores， clinical efficacy rate， pancreatitis and inflammation markers， postoperative liver function， and CBDS recurrence rate at 1-year follow-up， which were used to jointly evaluate the clinical efficacy and safety of both groups. ResultsA total of 56 patients completed the study and were included in the final analysis， i.e.， 29 in the observation group and 27 in the control group. Baseline characteristics were comparable between the two groups. Compared with pre-treatment and with the control group after treatment， the bile bilirubin level in the observation group significantly decreased （P<0.05）. After treatment， the clinical cure and marked improvement rates were higher in the observation group than in the control group， showing a statistically significant difference in overall clinical efficacy （P<0.05）. Compared with pre-treatment， the primary and secondary symptoms in the observation group， as well as the primary symptom and the secondary symptom of nausea and vomiting in the control group （weeks 4 and 8）， were significantly reduced （P<0.05）. Compared with the control group after treatment， the observation group showed significant reductions in the primary symptom of loose stools/constipation （day 5 and week 4） and in three secondary symptoms， i.e.， bitter taste and sticky dry mouth， abdominal distension and poor appetite （throughout the treatment period）， and general heaviness and fatigue （day 5 and week 4）， with statistical differences （P<0.05）. Compared with pre-treatment， both groups showed decreased lipase and urinary amylase levels （P<0.05）. However， no significant between-group differences were observed in pancreatitis or inflammation-related indices after treatment. Compared with pre-treatment， all liver function indicators in the observation group and alanine aminotransferase （ ALT ）， γ-glutamyl transferase （ γ-GT ）， alkaline phosphatase （ALP）， and conjugated bilirubin in the control group significantly decreased at weeks 4 and 8 （P<0.05）. Compared with the control group after treatment， only serum total bilirubin and unconjugated bilirubin were significantly reduced in the observation group during the treatment period （P<0.05）. ConclusionYYLD combined with conventional Western medical treatment can effectively regulate bilirubin metabolism （in bile and serum）， improve TCM clinical symptoms， and prevent CBDS recurrence after ERCP in patients with liver and gallbladder dampness-heat syndrome. This regimen is safe and effective and is worthy of further clinical research and promotion.

Objective:To investigate the effect of the combined general and epidural anesthesia on tissue perfusion and intestinal barrier in elderly patients undergoing radical resection of colorectal cancer.Methods:A total of 118 elderly patients with colorectal cancer admitted to our hospital from January 2018 to September 2019 were randomly divided into two groups: a single general anesthesia(control, n=59)and combined general and epidural anesthesia(observation, n=59). Two groups underwent radical resection of colorectal cancer.The perioperative parameters were compared between the two groups, including tissue perfusion[central venous-to-arterial carbon dioxide difference(Pcv-aCO 2), oxygen delivery index(DO 2I), oxygen consumption index(VO 2I), difference between central venous and arterial lactate(Dcv-aLac), oxygen extraction rate(O 2ER), central venous oxygen saturation(ScvO 2)], and intestinal barrier[diamine oxidase(DAO), D-lactic acid(D-Lac)]. Results:Compared with the control group, the ScvO 2 during T2-T4 periods was increased in the observation group, and the VO 2I, Dcv-aLac and Pcv-aCO 2 during T1-T4 periods were reduced in observation group( P<0.05). The DO 2I during T1-T4 periods was slightly higher in the observation group than in the control group, and the O 2ER was slightly lower in the observation group than in the control group, but the differences were not statistically significant, ( P>0.05). In the both two groups, the D-Lac and DAO levels showed a gradual upward trend during T1-T5 periods and a gradual downward trend during T5-T6 periods.The D-Lac and DAO levels during T2-T6 periods were lower in observation group than in the control group( P<0.05)[during abdominal exploration(T1); invitrolesion(T2); before abdominal closure(T3); after surgery(T4); postoperative day 1(T5); postoperative day 3(T6)]. Conclusions:General anesthesia combined with epidural anesthesia in elderly colorectal cancer patients undergoing radical resection can stabilize perioperative tissue perfusion, decrease intestinal barrier injury and increase anesthetic effect.

Objective To investigate the relationship between the right-to-left shunt(RLS)detected with contrast-enhanced transcranial Doppler (c-TCD) and recurrent stroke in patients with cryptogenic stroke.Methods The consecutive patients w ith ischemic stroke w ere enrol ed. The patients w ith cryptogenic stroke w ere screened according to the TOAST criteria. They w ere divided into either a RLS positive group or a RLS negative group according to the c-TCD findings, and then they w ere fol ow ed up for a period of one year. They w ere also divided into a recurrent group and a non-recurrent group according to w hether they had recurrence or not. Results A total of 118 patients w ith cryptogenic ischemic stroke w ere enrol ed, including 46 in the RLS positive group, 72 in the RLS negative group, 10 in the recurrent group, and 108 in the non-recurrent group. There w ere no significant differences in demographic and baseline data betw een the RLS negative group and the RLS positive group. There w ere significant differences in RLS positive rate (7/10 vs.39/108; P=0.046) and proportion of patients with server RLS (2/10 vs.1/108; P=0.019) betw een the recurrent group and the non-recurrent group. Multivariate logistic regression analysis show ed that the positive RLS w as an independent predictor of recurrent stroke (odds ratio 4.896, 95% confidence interval 1.135-21.120;P=0.033). Conclusions The positive RLS may be an independent risk factor for the recurrence in patients w ith cryptogenic ischemic stroke.

Objective To explore the effects of general anesthesia for postoperative cognitive function in elderly orthopedic patients.Methods Elderly patients with orthopedic patients in the First People's Hospital of Shangqiu from June 2010 to September 2013 were randomly divided into general anesthesia group(n=74) and epidural group(n=74),and the cognitive functions of patients were observed by the minimum mental status examination(MMSE) score before and after treatment.Results The differences between the heart rate (HR),mean arterial pressure (MAP),pulse Oxygen Saturation (SpO2) and surgical observation indicators in both groups were not statistically significant(P＞0.05).MMSE score in general anesthesia group and epidural group decreased significantly at day 1((18.4± 1.6) point,(21.2± 2.5) point) and day 7 ((20.5± 2.3) point,(23.4 ±2.1) point) after treatment than before treatment ((24.4±2.2) point,(24.5±2.1) point;F inner group =13.56,P＜0.01;F between group=12.46,P＜0.01;F across group=11.80,P＜0.01).The incidence rates of POCD scores in the epidural group were lower than those in the general anesthesia group.But the difference was not statistically significant (P＞0.05).Conclusion Both general anesthesia and epidural anesthesia impacts on cognitive function in elderly patients after orthopedic surgery,but the impact of general anesthesia is greater.

Objective To explore and analysis the clinical effect of ropivacaine combined with spinalepidural anesthesia in anorectal surgery and to evaluate the safety of this method.Methods We retrospective analyzed the clinical information of 82 patients who conducted with selective anorectal surgery in the First People's Hospital of Shangqiu from January 2010 to December 2013.The patients were randomly divided into bupivacaine group and ropivacaine group,and each group of 41 cases.Both groups took the way of combined with spinal-epidural anesthesia to waist L3/L4 point gap.Bupivacaine and ropivacaine group were traited at a rate of 0.2 ml/s bolus of 0.375％ bupivacaine and ropivacaine solution of 2 ml.Compare the satisfaction and anesthetic effect of two groups.Results None of the patients have received additional drugs again in intraoperative period,and the surgery was performed without a hitch.The sensory blockade working time,the biggest feeling block plane and duration of sensory blockade of all of the patients in two groups have not showed any difference (P＞0.05),while in ropivacaine group,the biggest feeling block plane ((1.8 ± 0.4) vs (2.9± 0.3) score) was lower and the sensory blockade working time((9.8±0.6) min vs (3.5±0.4) min) was late,and the difference showed statistical significance between two groups (t =2.4236,2.4265;P ＜ 0.05).There was no significant difference of the patients satisfaction degree of the anesthesia,anesthesia level can satisfy the requirement of the surgery muscle relaxant.Conclusion Compared with bupivacaine group,sanesthesia,ropivacaine not only can help anorectal surgery in patients with postoperative recovery,but also could meet the requirements of the non-pain and non-inductive in perioperative operation patients,it is worth in anorectal surgery clinical reference and promotion.