Objective:To establish an HPLC method for the simultaneous determination of narirutin, limonin, honokiol and mag-nolol in Zhishi Xiaopi pills. Methods:The separation was performed on a Shim-pack VP-ODS C18(250 mm ×4.6 mm,5 μm)column with the mobile phase consisting of acetonitrile–methanol(1 ∶2) (A) and water (B) with gradient elution. The flow rate was 1. 0 ml ·min-1 . The column temperature was 30℃. All the injection volume was 20 μl. Narirutin, limonin, honokiol and magnolol was de-tected at 283 nm, 210 nm, 294 nm and 294 nm, respectively. Results:Narirutin, limonin, honokiol and magnolol had good linearity within the concentration range of 5. 26-105. 20 μg·ml-1(r=0. 999 8), 7. 65-153. 00 μg·ml-1(r=0. 999 4), 6. 21-124. 20 μg· ml-1(r=0.999 3)and 6.45-129.00 μg·ml-1(r=0.999 6), respectively; the average recovery was 99.00%(RSD=0.77%), 98. 17%(RSD=1. 19%), 98. 78%(RSD=0. 86%) and 97. 90%(RSD=0. 99%), respectively. Conclusion: The method is sim-ple, rapid and reliable, which can be used for the quality control of Zhishi Xiaopi pills.

BACKGROUND:Recently, the clinical repair methods of irregular wound on fingers primarily include local pedicled flap and free mini-flap of upper extremities or lower extremities.
OBJECTIVE:To discuss the application of free mini-flap derived from upper limb in repairing the wound on fingers.
METHODS:From December 2010 to February 2014, 12 patients with irregular wounds on 12 fingers were selected from Department of Traumatic Orthopaedics and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, China. The size of wounds ranged from 1.5 cm × 2.0 cm to 3.0 cm × 4.5 cm with different degrees of bone or tendon exposure. After the debridement, 12 patients were treated by free mini-flaps of upper limb. The donor sites were directly sutured.
RESULTS AND CONCLUSION:Among the 12 patients, al the wounds at recipient and donor sites were healed at stage I, and the free mini-flags survival completely. Al of patients were fol owed up for 3-6 months (average 4.5 months). Free mini-flags had good appearance and needn’t undergo secondary trimming. The active motion of fingers was improved dominantly. According to the criteria of Hand Surgery Association Society of Chinese Medical Association Society for the function evaluation of upper limb, three cases were excellent, eight were good, and only one was bad. The excellent and good rate was 91%. Free mini-flaps of upper limb are an ideal method for repair of wounds on fingers. It has no injury to normal tissue in hands, donor site is very secluded, and the short-term curative effect is good.

Methods The clinical data of 4445 cases (5 530 hernias) who underwent LIHR at Ruijin Hospital from Jan 2001 to Dec 2015 were analyzed retrospectively.2 125 cases underwent 2 402 trans-abdominal preperitoneal procedure(TAPP),2 306 cases did 2 907 totally extraperitoneal (TEP),and 21 IPOMs in 20 cases.There were 3 216 indirect hernias (60.3％),1 164 direct hernias (21.8％),399 recurrent hernias (7.5％),479 complex hernias (9.0％),and 72 femoral hernias (1.4％).The median time of follow-up is 51 months with a range between 7 and 187 months.Results The average operation time was 27.1 ± 8.7 min for unilateral hernia repair,and 43.0 ± 11.0 min for bilateral hernia repair.The average hospital stay was 1.4 ± 1.1 d.There were 250 seroma (4.7％),68 urinary retention (1.3％),23 transient neuropraxia (0.4％) and 3 paralytic obstruction of intestines (0.1％).Severe complications included 1 port site hernia,1 intestinal injury,and 1 mechanical intestinal obstruction.After a medium follow-up of 51 months,there were 13 recurrent cases (0.24％),including 5 cases after TAPP,7 after TEP,1 after IPOM.Conclusion LIHR is a safe and efficient technique for hernia repair.

Objective To explore the clinical efficacy of laparoscopic inguinal hernia repair (LIHR) in elderly patients.Methods The retrospective cohort study was adopted.The clinical data of 3 203 patients with inguinal hernias (3 847 sides) who were adnitted to the Ruijin Hospital of Shanghai Jiaotong University School of Medicine between January 2001 and December 2013 were collected.Of 3 203 patients,979 (1 107 sides) with age ＜ 60 years and 2 224 (2 740 sides) with age ≥ 60 years were respectively allocated into the under 60 years group and 60 years or older group.The surgical procedures including transabdominal preperitoneal (TAPP) approach,total extraperitoneal (TEP) approach and intraperitoneal onlay mesh (IPOM) approach were selected and performed by doctors in the same team.There were light-weight and heavy-weight patches.Observation indicators included (1) overall operation situations,(2) surgical comparison between the 2 groups,(3)comparison of postoperative indicators between the 2 groups,(4) follow-up.Follow-up using telephone interview and outpatient examination was performed to detect the recovery time of non-restricted activity,recurrence of hernia and complications.Measurement data with normal distribution were represented as ~ ± s and comparison between groups was done by the t test.Comparisons of count data were analyzed using the chi-square test or Fisher exact probability.Ranked data were compared by the nonparametric rank sum test.Results (1) Overall operation situations:3 203 patients with inguinal hernias (3 847 sides) underwent LIHR,including 1 475 (1 677 sides) using TAPP approach,1 718 (2 154 sides) using TEP approach and 10 (16 sides) using IPOM approach (6 using TAPP and IOPM approaches in each side).The light-weight patch was used in 2 206 sides and heavy-weight patch was used in 1 641 sides.Operation time was (31 ± 12) minutes in all 3 203 patients,(27 ±9)minutes in 2 559 patients with unilateral hernia and (44 ± 12)minutes in 644 patients with bilateral hernia,respectively.Duration of postoperative hospital stay was (1.5 ± 1.2) days.(2) Surgical comparison between the 2 groups:TAPP approach,TEP approach,IPOM approach,light-weight patch and heavy-weight patch were performed to 567,538,2,751,356 sides in the under 60 years group and 1 110,1 616,14,1 455,1 285 sides in the 60 years or older group,respectively,with statistically significant differences in above indicators between the 2 groups (X2 =37.976,70.022,P ＜ 0.05).Operation time in unilateral hernia and bilateral hernia and total operation time were (27 ± 9)minutes,(42 ± 10)minutes,(29 ± 10)minutes in the under 60 years group and (27 ± 10)minutes,(44 ± 12)minutes,(3 1 ± 13)minutes in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (t =-0.106,-1.768,-4.445,P ＞ 0.05).(3) Comparison of postoperative indicators between the 2 groups:the pain score at postoperative day 1 and duration of postoperative hospital stay were 2.4 ± 1.1,(1.5 ± 1.1) days in the under 60 years group and 2.3 ± 1.0,(1.5 ± 1.3) days in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (t =1.419,-0.126,P ＞0.05).(4) Follow-up:all the patients were followed up for 23-60 months,with a median time of 43 months.Cases with non-restricted activity recovery at postoperative week 2 and 4 were 973,978 in the under 60 years group and 2 208,2 222 in the 60 years or older group,respectively,showing no statistically significant difference between the 2 groups (X2=0.113,P ＞0.05).The recurrence of hernia,severe complications,serum tumescence,paresthesia and enteroparalysis were detected in 1,0,49,5,1 sides in the under 60 years group and 11,3,132,16,2 sides in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (x2=1.556,0.269,0.254,P ＞ 0.05).The urinary retention in the under 60 years group and 60 years or older group was respectively detected in 6 and 44 sides,showing a statistically significant difference between 2 groups (x2=6.956,P ＜ 0.05).Conclusion LIHR is safe and effective in elderly patients,and it can achieve good clinical efficacy under selecting reasonable operation procedures and patches.

The magnamosis device for stage-one repair of the rectovaginal tistula consists of two arc magnets. Drawing the interrupting thread along the fistula margin via the vaginal side, and pulling the string to arrange the magnets at the fistula base along the long axis of the vagina, we made the magnamosis device automatically clipped to seal the fistula. After removing the threads we kept the device for 2-4 weeks till the natural detachment of it when the compressed tissue in between healed after vascular necrosis. This device utilizing the unique ability of magnamosis to fulfill anastomosis under inflammatory infected state reduces the current high relapse rate and colostomy drawbacks of the conventional rectovaginal neoplasty.
Female ; Gynecologic Surgical Procedures ; instrumentation ; methods ; Humans ; Magnetics ; Magnets ; Pressure ; Rectovaginal Fistula ; surgery ; Wound Healing

Objective To comprehensively analyze the effectiveness of exercise training-based respiratory rehabilitation therapy on patients with occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis"). MethodsLiterature on randomized controlled trials of exercise training-based respiratory rehabilitation therapy for pneumoconiosis patients published from the establishment of the database to July 2023 was retrieved from academic systems such as the China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, VIP Database, and China Biology Medicine using bibliometrics method. The RevMan 5.4 software was used for meta-analysis of the selected literatures. Subgroup analysis was conducted to explore the source of study heterogeneity. The funnel plot method was used to test publication bias. Results A total of 55 articles were included, involving 2 436 pneumoconiosis patients in the experimental group and 2 405 pneumoconiosis patients in the control group. The result of random or fixed effect model showed that the six minutes walking distance, the total score of Short from Health Survey-36, forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), FEV₁/FVC, arterial partial pressure of oxygen of pneumoconiosis patients increased after respiratory rehabilitation therapy (all P<0.05), while the total score of the St. George's Respiratory Questionnaire and arterial partial pressure of carbon dioxide decreased compared with the conventional treatment (all P<0.05). The result of subgroup analysis showed that the total score of the St. George's Respiratory Questionnaire, FEV₁, and the index of arterial partial pressure of oxygen of pneumoconiosis patients was better in the rehabilitation treatment for ≥six months compared with those

Objective To explore the effect of aspirin combined with metformin on the apoptosis of thyroid cancer TPC?1 cells and its mechanism. Methods The proliferation and apoptosis of TPC?1 cells treated with different concentrations of aspirin and metformin were detected using cell count kit?8 ( CCK?8) assay and flow cytometry, respectively. Western blot was used to detect the expressions of microtubule?associated protein light chain 3 (LC3), p62 and cysteinyl aspartate specific proteinase 3 ( caspase?3) after treatment with aspirin, metformin and 3?Methyladenine ( 3?MA). Results The relative cell viability of TPC?1 cells treated with 0.5, 1.0, 2.0, 4.0 mmol／L aspirin for 24 and 48 hours were ( 85.6 ± 9.1)%, (79.9±8.6)%, (57.0±5.3)%, (55.7±5.4)%; (76.7±2.8)%, (75.4±6.1)%, (46.1±4.1)%, (36.3±3.2)%, respectively. The value of half maximal inhibitory concentration ( IC50 ) for 24 and 48 hours were 4.297 mmol／L, 2.133 mmol／L, respectively. The apoptotic rate in the 1 mmol／L aspirin treatment group and negative control group were (29.2±8.5)%,(4.2±2.9)%, respectively (P＜0.05). Moreover, treatment with metformin increased the protein expression of LC3Ⅱ／Ⅰ ratio, and decreased the expression of p62, while treatment with aspirin decreased the expression of LC3Ⅱ／Ⅰ ratio and increased the expression of p62. The relative cell viability of TPC?1 cells treated with metformin, 3?MA, an autophagy inhibitor, and 3?MA combined with metformin were (73.2±9.2)%, (95.8±3.3)%, (59.9±9.2)%, respectively. The apoptotic rates in these groups were (35.5±1.5)%, (12.3±1.4)%, (49.9±5.4)%, respectively. Compared with the metformin group, the relative cell viability in metformin combined with 3?MA group was significantly lower while the apoptotic rate was higher ( P＜0.05), which indicated that treatment with 3?MA enhanced the metformin?induced apoptosis of TPC?1 cells. The relative cell viability of TPC?1 cells in metformin group, aspirin group, metformin combined with aspirin group were ( 87.3 ± 11.8)%, ( 85.7 ± 9.6)%, ( 72.4 ± 8.8)%, respectively. The apoptotic rates in these groups were ( 29.7± 4.0)%, (30.5 ± 6.5)%, ( 52.5 ± 4.6)%, respectively. Compared with the metformin or aspirin group, the relative cell viability in metformin combined with aspirin group was significantly lower, while the apoptotic rate was higher ( P＜0.05), which indicated that aspirin enhanced the metformin?induced apoptosis of TPC?1 cells. Conclusions Our findings indicate that metformin?mediated autophagy plays a protective role in metformin?induced apoptosis and proliferation inhibition. Aspirin enhances the metformin?induced apoptosis of thyroid cancer TPC?1 cells through inhibition of autophagy.

Objective To explore the effect of aspirin combined with metformin on the apoptosis of thyroid cancer TPC?1 cells and its mechanism. Methods The proliferation and apoptosis of TPC?1 cells treated with different concentrations of aspirin and metformin were detected using cell count kit?8 ( CCK?8) assay and flow cytometry, respectively. Western blot was used to detect the expressions of microtubule?associated protein light chain 3 (LC3), p62 and cysteinyl aspartate specific proteinase 3 ( caspase?3) after treatment with aspirin, metformin and 3?Methyladenine ( 3?MA). Results The relative cell viability of TPC?1 cells treated with 0.5, 1.0, 2.0, 4.0 mmol／L aspirin for 24 and 48 hours were ( 85.6 ± 9.1)%, (79.9±8.6)%, (57.0±5.3)%, (55.7±5.4)%; (76.7±2.8)%, (75.4±6.1)%, (46.1±4.1)%, (36.3±3.2)%, respectively. The value of half maximal inhibitory concentration ( IC50 ) for 24 and 48 hours were 4.297 mmol／L, 2.133 mmol／L, respectively. The apoptotic rate in the 1 mmol／L aspirin treatment group and negative control group were (29.2±8.5)%,(4.2±2.9)%, respectively (P＜0.05). Moreover, treatment with metformin increased the protein expression of LC3Ⅱ／Ⅰ ratio, and decreased the expression of p62, while treatment with aspirin decreased the expression of LC3Ⅱ／Ⅰ ratio and increased the expression of p62. The relative cell viability of TPC?1 cells treated with metformin, 3?MA, an autophagy inhibitor, and 3?MA combined with metformin were (73.2±9.2)%, (95.8±3.3)%, (59.9±9.2)%, respectively. The apoptotic rates in these groups were (35.5±1.5)%, (12.3±1.4)%, (49.9±5.4)%, respectively. Compared with the metformin group, the relative cell viability in metformin combined with 3?MA group was significantly lower while the apoptotic rate was higher ( P＜0.05), which indicated that treatment with 3?MA enhanced the metformin?induced apoptosis of TPC?1 cells. The relative cell viability of TPC?1 cells in metformin group, aspirin group, metformin combined with aspirin group were ( 87.3 ± 11.8)%, ( 85.7 ± 9.6)%, ( 72.4 ± 8.8)%, respectively. The apoptotic rates in these groups were ( 29.7± 4.0)%, (30.5 ± 6.5)%, ( 52.5 ± 4.6)%, respectively. Compared with the metformin or aspirin group, the relative cell viability in metformin combined with aspirin group was significantly lower, while the apoptotic rate was higher ( P＜0.05), which indicated that aspirin enhanced the metformin?induced apoptosis of TPC?1 cells. Conclusions Our findings indicate that metformin?mediated autophagy plays a protective role in metformin?induced apoptosis and proliferation inhibition. Aspirin enhances the metformin?induced apoptosis of thyroid cancer TPC?1 cells through inhibition of autophagy.

Objective To investigate the safety and efficacy of mechanical thrombectomy (MT) compared with In?tra-arterial Thrombolysis (IAT) treatment in patients with severe acute ischemic stroke (AIS) caused by large cerebral ar?tery occlusion. Method The patients with AIS caused by large cerebral artery occlusion and underwent MT or IAT from 2005 May to 2014 May was included. A retrospective analysis was conducted on the onset to emergency(OTE)time, emergency to acupuncture(ETA)time, acupuncture to recanalization (ATR) time, stroke severity as measured by the Na?tional Institutes of Health Stroke Scale (NIHSS) score, and site of arterial occlusion on magnetic resonance angiography (MRA). A comparison was made between MT and IAT patients in rates of recanalization, symptomatic intracranial bleed?ing (SIB), mortality, and functional outcome. Three-month favourable outcome was defined as a modified Rankin Scale (mRS) score≤2. Result One hundred and two AIS patients were treated with MT and 50 with IAT. There was no differ?ence between MT and IAT groups with regard to demographics, onset NIHSS score (13.37±6.95 vs. 12.70±6.11;P=0.572) and discharge NIHSS score (8.40 ± 6.69 vs. 7.53 ± 7.28, P= 0.522) and the change of NIHSS score (3.87 ± 7.14 vs. 4.26 ± 5.42, P=0.766). There were significantly differences between MT and IAT groups in the OTE time (Median 300 min vs. 120 min,Z=-5.704,P=0.000) , ATR time (Median 30 min vs. 65 min,Z=-5.011,P=0.001) ,recanalization (91.2%vs. 60.0%,P =0.01),the rate of AIB(21.7% vs. 36.0%,P =0.046),3-month mortality (16.6% vs. 26.0%,P =0.043). The above parameters were better in MT group than in the IAT group. There were no significant differences between MT and IAT groups in the rate of SIB (12% vs. 16%,P =0.055), the NIHSS change(Median 3 vs. 4,Z =-0.236,P =0.823) and mRS score on 90d ( 48.2%vs. 46.0%, P=0.823). MT patients had significantly higher percentages of stent use (22.5%vs. 8%,P=0.018) . The Recanalization for ICA(81.8%vs. 55.6%,P=0.048),BA(93.1%vs. 55.6%,P=0.032)and MCA( 97.5% vs. 60.0%,P =0.026)was higher in MT group than in IAT group .The SIB rate for ICA(13.8% vs. 33.3%,P =0.000),BA(13.8%vs. 33.3%,P=0.000)was lower in MT group than in IAT group . The mortality rate of was significant?ly lower in MT than in IAT group for MCA (2.5%vs. 20.0%,P=0.000) . the good outcome rate for BA was higher in MT group than in IAT group(41.3%vs. 22.2%,P﹤0.01). Conclusions Compared to IAT,MT can provide broader time win?dow,higher recanalization rate and better outcome in patients with severe acute ischemic stroke (AIS) caused by large ce?rebral artery occlusion.

Extremity compartment syndrome can cause neuromuscular ischemia and deposition of metabolites in the compartment,leading to irreversible lesions which harm limb functions in the end.It is a great challenge for surgeons to make a timely and accurate diagnosis of the syndrome in adults and children.The key is evaluation of the clinical symptoms and intracompartmental pressure.In this paper we summarize the epidemiology,etiology,pathophysiology,and current diagnosis and treatment of acute extremity compartment syndrome of the upper and lower extremities in adults and children.