Purpose:To study the appropriate surgical treatment for ductal carcinoma in situ of the breast ( DCIS ).Methods:16 patients with DCIS treated between Jan 1994 and Dec 2003 were evaluated. All patients underwent lumpectomy and intraoperative frozen section evaluation. The median age was 43 years ( range 30 to 84 ) and the median pathologic size of DCIS was 2.0cm ( range 0.3 to 4cm ). 2 of these 16 patients had Halsted radical mastectomy, 11 had modified radical mastectomy, 2 had simple mastectomy and 1 had breast-conserving surgery ( quadrant excision plus axillary lymph node dissection ). As postoperative treatment, 3 patients received radiotherapy, 8 received chemotherapy and 10 had endocrine therapy.Results:2 patients were found to have axillary micrometastases. The median follow-up time was 62(6～114)months. All patients survived without recurrence. Only one patient was found to have metastasis in hipbone 4 years after operation.Conclusions:Lumpectomy or wider excision plus postoperative radiotherapy is feasible for most patients with DCIS.[

Objective To investigate the clinical features of cryptogenic multifocal ulcerous stenosing enteritis(CMUSE),and to improve the diagnosis of this rare disease.Methods From 2010 to 2015,clinical data of 10 patients with CMUSE were retrospectively analyzed,including clinical features,laboratory examination,imaging examination,appearance under endoscopy,pathologic characteristics,location of lesions,treatment and prognosis.Results Among the 10 patients with CMUSE (male six,female four),the mean age was (35.1±14.8) years.The predominant clinical manifestation was melena (eight cases),abdominal pain (eight cases) and anemia (nine cases).The results of laboratory examination showed normal in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).Among seven patients,hypersensitive C reactive protein (hsCRP) of two patients increased.Imaging examination showed intestinal stricture and appearance under endoscopic examination was intestinal ulcers and stenosis.Pathologic finding was superficial ulcers at mucosal and submucosal layers.Lesions mostly involved small intestine,and one case involving ileocecal valves and rectum.Among the 10 patients,seven patients received combination of surgical resection and prednisone treatment,and three patients were only administrated with medications.After treatment,seven patients remainedremission and three patients relapsed after remission.Immunosuppressors and enteral nutrition was effective in two of them and glucocorticoid resistance happened in one patient.Conclusions The diagnosis of CMUSE should he considered in patients with unexplained recurrent bowel obstruction,melena,anemia and concomitant intestinal ulcer and stricture.Endoscopy plays an important role in the diagnosis.Glueocorticoid is effective but easy to relapse.Immunomodulators and enteral nutrition may be considered as second-line therapy.

Objective To assess the nutritional risk of patients with inflammatory bowel disease (IBD).Methods The nutritional status of 112 IBD patients from PUMC Hospital were evaluated by Nutritional Risk Screening 2002 (NRS 2002).Using Chinese standard,a body mass index (BMI) that was lowered than 18.5 kg/m~2 according to clinical material was regarded as malnutrition,and the score was recorded as 3.The se-verity of ulcerative colitis (UC) was evaluated using True-Love criteria as mild,moderate,and severe.Crohn's disease (CD) was evaluated using Harvey-Bradshaw Index as in remission stage (≤4),moderately active stage (4-8),and severely actively stage (≥9).Results All these 112 patients,including 70 UC cases and 42 CD cases,were evaluated by NRS2002.Forty-five patients (40.2%) were judged as at the risk of malnutrition.The incidence of malnutrition was significantly higher in CD patients than in UC patients (52.4% vs.32.9%,P<0.05).It was also significantly correlated with the severity of disease.In patients with severe IBD,the rate of mal-nutrition evaluated by BMI according to clinical material was significantly lower than the rate of nutritional risk.Con-clusions The risk of malnutrition is high in IBD patients.NRS 2002 can be used for nutritional risk screening.

Objective Laparoscopy-assisted distal gsstrectomy (LADG) with D1 + β lymph node dissection has become the most popular treatment for early gastric cancer in Asian countries. However, no one has shown the same clinical advantages with this procedure as with LADG with D1 + α lymph node dissection. The aim of this study was to compare the outcome of LADG with D1 + β to that of LADG with D1 + α lymph node dissection. Methods During the period of June 2002 through June 2006, LADG with D1 + α lymph node dissection was performed in 54 patients, and LADG with D1 + β lymph node dissection was performed in 42 patients. Surgical findings, clinicopathologic data, postoperative course, complications, and blood analysis findings were compared between the two groups. Differences were analyzed with Mann-Whitney U test and chi-square test. Results Patients in the two groups were comparable with respect to age, sex, body mass index, and stage and pathologic characteristics of gastric cancer. A significantly greater number of N2 lymph nodes were harvested by D1 + β lymph node dissection than by D1 + α dissection (5.9vs. 2.7, P<0.01). However, no significanees in the total number of retrieved lymph nodes (24.7 vs. 22.2) or perigastric lymph nodes dissected (18.9 vs. 19.4) were identified between the D1 + β and D1 +α groups. There was also no significant difference between the D1 + α and D1 + β groups with respect to operation time, blood loss, complication rate, time to first walking, first flatus, first eating, and first defecation, frequency of analgesics, volume of oral intake on postoperative day 7, weight loss, and postoperative hospital stay. Blood analysis showed there were no significant differences in white blood cell count, levels of C-reactive protein, and serum albumin. Conclusion The short-term outcome of LADG with D1 + β lymph node dissection is comparable to that of LADG with D1 + α lymph node dissection.

From the TCM theoretical basis and the evidences of acupoint selection and acupuncture and moxibustion methods regarding acupuncture for post-traumatic stress disorder (PTSD), a theoretical discussion is made in this article, also a review regarding the key mechanism of experiment researches on acupuncture for PTSD is made from aspects of neurobiology and brain functional imaging, etc., which could further clarify the effect mechanism of acupuncture on PTSD. It is found that PTSD is a kind of stress syndrome accompanied with a variety of abnormal mental symptom , and acupuncture has superior effect on PTSD. Based on these, the research progress and deficiency on current mechanism study of PTSD are reviewed, hoping to offer ideas for upcoming research and to serve the clinical practice better.
Acupuncture Points ; Acupuncture Therapy ; methods ; trends ; Humans ; Moxibustion ; Stress Disorders, Post-Traumatic ; therapy

Objective To investigate the long-term oncological outcomes of laparoscopic radical hysterectomy (LRH) plus lymph node dissection (LND) and abdominal radical hysterectomy (ARH) plus LND for patients with stage Ⅰ a2-Ⅱ a2 cervical cancer.Methods A retrospective review of stage Ⅰ a2-Ⅱ a2 cervical cancer patients who underwent LRH + LND (n=372) and ARH + LND (n=434) at the First Affiliated Hospital of Sun Yat-sen University from Jan.2005 to Aug.2013 was performed.Individual patient matching was performed by the risk factors for recurrence [tumor size,lymph vascular space invasion (LVSI),depth of cervical stromal invasion,lymph node metastasis,parametrialinvolvement,and resection margin involvement] between two groups.After matched,a total of 203 patient pairs (LRH-ARH) were enrolled.The survival data,surgery data,intraoperative and postoperative complications were compared between the two groups.To assess the prognosis factors,the univariate and multivariate Cox's proportional hazards modelanalysis were conducted.Stratified analysis was performed based on the independent prognosis factors to investigate the survival data between the two surgery groups.Results (1) Surgery data:The operating time [(239±44) vs (270±42) minutes],estimated blood loss [(210± 129) vs (428±320) ml],the duration of bowel motility return [(2.0±0.8) vs (3.0± 1.6) days] and hospital stay [(11 ±6) vs (13±6) days] in the LRH group were significantly shorter than those in ARH group (all P＜0.01).(2) Intraoperative and postoperative complications:The intraoperative complications rate was similar betweentwo groups [6.4％(13/203) vs 6.9％(14/203),P=1.000].The rate of postoperative complications (excluded bladder dysfunction) in the LRH group were significantly lower than those in the ARH group [9.4％ (19/203) vs 20.2％ (41/203),P=0.002].While there was no significant difference in the rates of bladder dysfunction between two groups [36.5％ (74/203) vs 37.4％ (76/203),P=0.910].(3) Recurrence and survival data:There was no significant difference in the recurrence rates between the LRH group and ARH groups [7.9％ (16/203) vs 9.4％ (19/203),P=0.850].There were similar 5-year recurrence-free survival (RFS;92.1％ vs 91.1％,P=0.790) and 5-year overall survival (OS;93.7％ vs 96.1％,P=0.900).(4) Prognosis factor:In univariate analysis,the results showed that tumor size,International Federation of Gynecology and Obstetrics (FIGO) stage,adjuvant therapy,LVSI,stromal invasion,parametrium invasion,pelvic lymph node metastasis,and para-aortic lymph node metastasis were significantly associated with poor prognosis (all P＜0.01).However,age,body mass index (BMI),surgery type,histological type,grade were not significantly associated with poor prognosis (all P＞0.05).The multivariate analysis results,showed that tumor size,pelvic lymph node metastasis,and para-aortic lymph node metastasis were significantly associated with poor prognosis (all P＜0.01).Stratified analysis showed that,even in patients with tumor size ＞4 cm,pelvic lymph node metastasis positive,and para-aortic lymph node metastasis positive in all subgroups,there were not significant difference for the estimated 5-year RFS and 5-year OS between LRH and ARH group (all P＞0.05).Conclusion For patients with stage Ⅰ a2-Ⅱ a2 cervical cancer,LRH plus lymph node dissection is an oncologically safe and surgical feasible alternative to ARH.

Objective To evaluate the performance of split-dosed polyethylene(PEG) for colonoscopy preparation.Methods Split-dose means that 1-3 L of PEG is taken in the afternoon or evening before examination and the remains in the next morning.And single-dose refers to all PEG is taken in the evening before ex-amination.A meta-analysis was conducted to compare bowel preparation quality,adenoma detection rate and patients' acceptance between groups.Results Ten randomized controlled trials were included into this study with 3 222 participants(1 481 in split-dose group and 1 741 in single-dose group).Split-dose group had higher rate of satisfactory bowel preparation(OR=3.37,95％CI:2.37-4.79),and so did the subgroup of 2～ 3 L PEG (OR =3.88,95％ CI:2.39-6.29).Split-dose group did not improve adenoma detection rate significantly (OR =0.94,95％ CI:0.71-1.24),but reported less adverse events such as nausea (OR =0.56,95％ CI:0.42-0.74)and vomiting(OR=0.51,95％CI:0.30-0.88).Conclusion Split-dosed PEG provides better colon cleansing with higher patient compliance,but does not improve detection rate of adenoma.

Objective To compare the clinical efficacies of totally laparoscopic and laparoscopy-assisted radical total gastrectomies.Methods The retrospective cohort study was conducted.The clinicopathological data of 373 patients with gastric cancer who underwent totally laparoscopic or laparoscopy-assisted radical total gastrectomies from the 7 medical centers in China (82 patients in the Affiliated Hospital of Qinghai University,80 in the Traditional Chinese Medicine Hospital of Guangdong Province,60 in the First Affiliated Hospital of Xiamen University,51 in the Hangzhou First People's Hospital,46 in the First Affiliated Hospital of Xi'an Jiaotong University,30 in the Second Affiliated Hospital of Jilin University and 24 in the Xijing Hospital of the Fouth Military Medical University) between January 2015 and December 2016 were collected.Of 373 patients,the 183 and 190 patients were respectively divided into the totally laparoscopic group (undergoing totally laparoscopic radical total gastrectomy) and laparoscopy-assisted group (undergoing laparoscopy-assisted radical total gastrectomy),including 63 and 19 in the Affiliated Hospital of Qinghai University,36 and 44 in the Traditional Chinese Medicine Hospital of Guangdong Province,25 and 35 in the First Affiliated Hospital of Xiamen University,20 and 31 in the Hangzhou First People's Hospital,10 and 36 in the First Affiliated Hospital of Xi'an Jiaotong University,17 and 13 in the Second Affiliated Hospital of Jilin University,12 and 12 in the Xijing Hospital of the Fouth Military Medical University.Routine five-port method was applied for laparoscopic radical total gastrectomy and D2 lymphadenectomy.Roux-en-Y anastomosis was applied for digestive tract reconstruction,and digestive tract reconstruction was performed under laparoscopy in the totally laparoscopic group and via upper abdominal median incision in the laparoscopy-assisted group.Observation indicators:(1) operation and postoperative situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative overall survival and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as x±s.Comparison between the groups was analyzed by the t test.Measurement data with skewed distribution were represented as M (range).Comparisons of count data were analyzed using the chi-square test and Fisher exact probability.Results (1)Operation and postoperative situations:all the patients in the 2 groups underwent successful operations,without perioperative death.Esophagojejunostomy methods of 183 patients in totally laparoscopic group:conventional circular stapler method were performed in 28 patients,anti-puncture circular staplar method in 6 patients,OrVilTM method in 5 patients,functional end-to-end esophagojejunostomy method in 65 patients and peristalsis side-to-side esophagojejunostomy method in 79 patients.Conventional circular stapler method was applied to 190 patients in the laparoscopy-assisted group.Operation time,time of esophagojejunostomy,length of assisted incision,using time of analgesics and expenses of digestive tract reconstruction were (238± 55)minutes,(29±9)minutes,(5.1 ± 1.1)cm,(2.2±l.0)days,(18 332±2 141)yuan in the totally laparoscopic group and (217±39)minutes,(26±7)minutes,(7.8 ±2.0)cm,(2.7± 0.9)days,(16 237 ± 1 923)yuan in the laparoscopy-assisted group,respectively,with statistically significant differences between the 2 groups (t =4.324,3.455,-16.835,-5.561,9.949,P＜0.05).The cases with postoperative overall complications,anastomosis leakage,anastomosis stricture,anastomosis bleeding and expenses of esophagojejunostomy were respectively 24,9,7,5,(9 668±2 814)yuan in the totally laparoscopic group and 24,8,9,6,(9 331 ±2 067)yuan in the laparoscopy-assisted group,with no statistically significant difference between the 2 groups (x2 =0.036,0.107,0.189,0.059,t=1.322,P＞0.05).All the patients with postoperative complications were cured by symptomatic treatment.(2) Follow-up and survival situations:of 373 patients,336 were followed up for 4-26 months,with a median time of 13 months,including 166 in the totally laparoscopic group and 170 in the laparoscopy-assisted group.During the follow-up,cases with overall survival,tumor recurrence and tunor metastasis were respectively 150,10,16 in the totally laparoscopic group and 154,9,16 in the laparoscopy-assisted group (10 and 9 patients in the totally laparoscopic and laparoscopy-assisted groups with simutaneous tumor recurrence and metastasis),showing no statistically significant difference between the 2 groups (x2 =0.075,0.010,P＞0.05).Conclusions Total laparoscopic and laparoscopyassisted radical total gastrectomies are safe and feasible,with equivalent overall outcomes and effects of esophagojejunostomy.Compared with laparoscopy-assisted radical total gastrectomy,the postoperative pain time of patients in total laparoscopic radical total gastrectomy is less,but there are longer time of esophagojejunostomy and higher expenses of digestive tract reconstruction.

Objective To investigate the diagnostic value of capsule endoscopy (CE), CT enterography (CTE), ileocolonoscopy and small bowel follow through (SBFT) for small bowel Crohn's disease (CD). Methods Fifty-seven consecutive patients with CD underwent ileocolonoscopy, CTE, CE, and SBFT. It included the presence of the following symptoms and signs: abdominal pain, weight loss,diarrhea, fever and positive fecal occult blood test. The location and the characteristics of intestinal and extra-intestinal lesions detected by four techniquks were compared. The proportions of patients with positive findings using each examination were compared. Results Of the 57 patients, 50 underwent ileocolonoscopy, terminal ileum lesion was found in 33 patients (66. 00% ), the remaining 17 (34.0%)were normal; among 34 patients who had CTE, 29 of small bowel lesion were found (85. 29% ); CE were performed in 27 patients, due to prolonged gastric transit one time, the capsule did not reach the cecum in one patient during battery lifetime. CE showed small bowel lesion in 26 patients (96.30% ); SBF was performed in 39 patients and 26 of small bowel lesion were detected (66. 67% ). CE had the highest diagnostic yield for CD and ileocolonoscopy had the lowest, and there were statistically significant difference among the 4 examinations (P = 0. 006 ). The combinded positive rates of two methods were: CE + CTE 92. 86% (13/14), SBFT + CTE 90. 91% (20/22), CE + ileocolonoscopy 95. 65% (22/23), CE + SBFT100% (17/17), ileocolonoscopy + CTE 89. 66% ( 26/29 ), ileocolonoscopy + SBFT 77.78% ( 28/36 ), but there were no significant differences between each two examinations. Conclusion CE, CTE have a higher yield in depicting mild to moderate finding of CD than SBFT. CE is better for assessing early mucosal disease,whereas CTE is better for detecting transmural and extraluminal abnormalities. Most important, CE plus CTE may depict nonobstructive CD of the small bowel when conventional techniques such as ileocolonoscopy or SBFF have negative or inconclusive finding. CE provides us explanations for the symptoms of patients, decision to follow up or therapy.

Objective To investigate the complications and the risk factors for pancreatic leakage after pancreaticoduodenectomy.Methods One hundred and sixty-nine patients who received pancreaticoduodenectomy in our hospital between January 2000 and December 2009 were reviewed.Chisquare and logistic statistic analysis were performed to determine the risk factors for pancreatic leakage.The difference in complication rates between different periods were analyzed.Results The mortality was 2.4％.The morbidity was 34.9％,and the pancreatic leakage rate was 7.7％.Logistic analysis revealed significant risk factors for pancreatic leakage included intraoperative bleeding of more than 400 ml(OR=2.87; 95％ confidence interval:1.17-8.19; P=0.048),soft texture of remnant pancreas(OR =1.95 ; 95 ％ confidence interval:0.87-6.19 ； P =0.032)and pancreatic duct diameter smaller than 3 mm(OR=3.78 ; 95 ％ confidence interval:1.01-10.63 ； P =0.019).There was no significant difference in mortality,morbidity,pancreatic leakage,and upper gastric bleeding between the periods 2000-2004 and 2005-2009.However,re-operation rate and postoperative hospital stay were significantly higher in the period of 2005-2009.Conclusions Intraoperative bleeding,soft texture of remnant pancreas and pancreatic duct diameter smaller than 3mm were significant risk factors for postoperative pancreatic leakage.A pancreaticojejunostomy anastomotic technique familiar to the surgeon might reduce postoperative pancreatic leakage.