OBJECTIVETo investigate the risk factors of intra-abdominal infection(IAI) after colorectal cancer surgery.

METHODSClinical and follow-up data of 773 colorectal cancer patients undergoing operation in our hospital from October 2011 to December 2014 were retrospectively analyzed. Patients were divided into intra-abdominal cavity infection group (110 cases, IAI group) and non intra-abdominal infection group(663 cases, non-IAI group). All the patients administered prophylactic antibiotics 30 minutes to 2 hours before operation. Univariate and multivariate analysis were performed to evaluate the risk factors of IAI.

RESULTSPreoperative factors associated with postoperative IAI included hepatic cirrhosis, kidney diseases, diabetes or other basic diseases, prophylactic use of drugs, hypoalbuminemia, anemia, intestinal obstruction, and American Society of Anesthesiologists (ASA) anesthetic grading score (all P<0.05). Postoperative factors associated with postoperative IAI included use of laparoscopy or stapler, united exenteration, existence of anastomotic fistula, time of drainage tube placement, operation time and tumor staging (all P<0.05). Multivariate logistic regression analysis showed that preoperative diabetes(OR=2.36, 95% CI:1.45 to 4.76, P<0.01), combined exenteration (OR=2.02, 95% CI:1.02 to 4.00, P<0.01), anastomotic leak (OR=4.41, 95% CI:1.77 to 10.99, P=0.001), operation time≥140 minutes (OR=2.88, 95% CI:1.78 to 4.67, P<0.01) and period of postoperative drainage≥10 days(OR=4.57, 95% CI:2.78 to 7.52, P<0.01) were independent risk factors of postoperative IAI, while the use of stapler was protective factor (OR=0.37, 95% CI: 0.23 to 0.60, P<0.01). Compared with prophylactic use of cephamycins plus metronidazole, cefuroxime plus metronidazole had a higher rate of IAI(OR=2.10, 95% CI:1.23 to 3.58, P=0.007).

CONCLUSIONSPrevention of postoperative IAI is required for colorectal cancer patients, particularly in those with preoperative diabetes, combined exenteration, anastomotic leak, operation time longer than 140 minutes and postoperative drainage period longer than 10 days. Preoperative use of cephamycins plus metronidazole has better efficacy in prevention of postoperative IAI.

Anastomotic Leak ; Colorectal Neoplasms ; surgery ; Digestive System Surgical Procedures ; adverse effects ; Drainage ; Humans ; Intestinal Obstruction ; Intraabdominal Infections ; epidemiology ; Laparoscopy ; Neoplasm Staging ; Postoperative Complications ; epidemiology ; Retrospective Studies ; Risk Factors

OBJECTIVE:To virtually screen potential α-glycosidase inhibitor ingredients from C. mori and F. mori,and to pro-vide reference for finding out new typeα-glycosidase inhibitor ingredient. METHODS:Surflex-Dock module of Sybyl-x 2.0 molecu-lar simulation software was used to perform the docking of small molecule compound,which was from the ingredients of C. mori and F. mori as ligand stated in literatures,with α-glycosidase. Total score of affinity scoring function was equal to 7 as the thresh-old value,to judge potential α-glycosidase inhibitor ingredient in C. mori and F. mori. RESULTS:After 70 small molecule com-pounds docked with α-glycosidase, 10 compounds showed binding activity (Total score≥7.00). Among them, moracin M-3′-O-β-D-glucopyranoside,5,7,2′-trihydroxyflavanone-4′-O-β-D-glucoside,mulberroside A,resveratrol-4,3′-di-O-β-D-gluco-pyranoside and 1,4-dideoxy-1,4-imino-(2-O-β-D-glucopyranosyl)-D-arabinitol had higher binding activity with α-glycosidase(Total score>8.00). CONCLUSIONS:Multi-constituents of C. mori and F. Mori show potential α-glycosidase inhibitory activity. The method is a kind of highly targeted,rapid and efficient approach to discover α-glycosidase inhibitor from traditional Chinese medi-cine.

Objective To investigate the clinicopathological factors associated with pathological complete response(pCR)of axillary metastatic lymph nodes in breast cancer patients after neoadjuvant chemotherapy(NAC),and to analyze the postoperative survival.Methods A total of 116 patients with breast cancer with axillary lymph node metastasis were collected from Jiaxing Hospital of TCM,Jiaxing Maternity and Child Health Care Hospital and The First Hospital of Jiaxing.Univariate analysis was used to analyze the relationship between clinicopathological factors and the pCR of axillary lymph node metastasis in breast cancer after NAC.Binary Logistic regression was used to analyze the independent predictors of the pCR of axillary lymph node metastasis in breast cancer after NAC.Kaplan-Meier survival curve was used to analyze the disease-free survival rate and overall survival rate of patients with and non-pCR of axillary metastatic lymph nodes.Results Among 116 patients,52 cases of axillary metastatic lymph nodes achieved pCR after NAC,accounting for 44.83%.Univariate analysis showed that age,vascular invasion,pCR of primary breast tumor,the difference of Ki67 before and after NAC,NAC regimen,and the efficacy of NAC were statistically significant between breast cancer patients with pCR and those non-pCR(P<0.05).Binary Logistic regression analysis showed that age,vascular invasion and pCR of primary breast tumor were independent predictors of pCR of axillary metastatic lymph nodes(P<0.05).The 5-year disease-free survival rate(80.40%vs.54.60%)and overall survival rate(90.4%vs.70.10%)of patients with pCR and non-pCR of axillary metastatic lymph nodes were compared.Conclusion Some breast cancer patients with axillary lymph node metastasis can reach pCR in lymph nodes after NAC.Analyzing the correlation between clinical pathological factors and pCR of axillary metastatic lymph nodes after NAC,it was found that pCR of axillary metastatic lymph nodes after NAC is related to age≤50 years old,no vascular infiltration,and primary breast tumor pCR.At the same time,it was found that patients with axillary metastatic lymph node pCR had a better prognosis than those with non-pCR.

AlM: To compare the duration of 0.25% ropivacaine used for sciatic nerve block between type 2 diabetic patients and non-diabetic patients, and to explore the factors affecting the duration of nerve block. METHODS: Sixty eight patients with unilateral lateral malleolus fracture who were to be treated with open reduction and internal fixation were selected from January 2021 to January 2022, aged 20-80 years old, ASA I-III, including 28 diabetic patients and 40 non-diabetic patients. All patients were given 0.25% ropivacaine 20 mL to the superior popliteal sciatic nerve under the guidance of ultrasound. The onset and duration of sensory block were evaluated by blunt needle stimulation. The onset and duration of motor block were evaluated by dorsiflexion and plantar flexion of the operated foot. The interval between the end of the operation and the patientls first request for analgesia was taken as the duration of nerve block analgesia. RESULTS: Compared with non-diabetic patients, the duration of sciatic nerve sensation, motor block and analgesia in diabetic patients were prolonged (P < 0.05). There was no significant difference in the onset time of sciatic nerve sensation and motor block between the two groups (P > 0.05). Linear regression analysis showed that diabetes mellitus, duration of diabetes mellitus, fasting blood glucose and glycosylated hemoglobin were factors affecting the duration of nerve block, and fasting blood glucose was not related to the duration of analgesia. CONCLUSlON: 0.25% ropivacaine can prolong the duration of sciatic nerve block in diabetic patients. The duration of diabetes, diabetes, fasting blood glucose and glycosylated hemoglobin are positively correlated with the duration of block.

Objective : To understand the epidemiological characteristics of intentional injury cases in Jiaxing from 2009 to 2016,and to provide basis for prevention and control of intentional injury. Methods: Data from the injury surveillance hospitals in Jiaxing from 2009 to 2016 were collected to learn the distribution and trend of gender,age,injury intention,cause,occurrence place,injured body parts and severity in intentional injury cases. Results: There were 8 089 cases of intentional injury reported by injury surveillance hospitals in Jiaxing from 2009 to 2016,accounting for 3.40% of all injury cases reported（237 912）. A total of 7 489 cases aged between 15 to 64 years old,accounting for 92.58%. There were 6 906 cases of violence and 1 183 cases of suicide or self-inflicted injury,accounting for 85.38% and 14.62%,respectively. The male-female ratio in the cases of violence was 2.54∶1,while the one in the cases of suicide or self-inflicted injury was 1∶1.59. The cases of violence was mainly caused by blunt instruments,accounting for 75.17%（5 191 cases）,while the cases of suicide or self-inflicted injury was mainly caused by poisoning,accounting for 47.76%（565 cases）. The cases of violence mainly occurred in streets,accounting for 29.64%（2 047 cases）,while the cases of suicide or self-inflicted injury mainly occurred at home,accounting for 82.59%（977 cases）. Head was the main injured parts in the cases of violence,accounting for 66.81%（4 614 cases）,while digestive system was the main injured parts in the cases of suicide or self-inflicted injury,accounting for 31.45%（372 cases）. About 0.12% of cases of the violence and 1.44% of cases of suicide or self-inflicted injury caused to death. Conclusion Intentional injury cases in Jiaxing were mainly young or middle aged people. Violence was a common intention of injury in males and suicide or self-inflicted injury was a common intention of injury in females.

Objective: To analyze the trend and distribution characteristics of the elderly fall cases in Jiaxing from 2009 to 2018,and to provide evidence for injury prevention and control. Methods: The injury monitoring data of Jiaxing sentinel hospitals from 2009 to 2018 was collected and analyzed the demographic features,places,results,involved body parts and severity of the fall cases aged 60 years or over. Results: There were 22 494 fall cases aged 60 years or over,accounting for 7.51% of all injury cases,28.79% of all fall cases,and 41.25% of the elderly injury cases. Fall was the first cause for injury among the elderly in Jiaxing. The proportion of the elderly fall cases to all injury cases and all fall cases increased year by year. There were 9 419 males,accounting for 41.87%,and 13 075 females,accounting for 58.13%. The average age was（71.19±8.55）years old in males and（72.59±9.09）years old in females. The falls mainly occurred at home,with 15 874 cases accounting for 70.57%. The falls mainly happened in the free time,with 11 133 cases accounting for 49.49%. The most serious injuries were fractures,with 9 640 cases accounting for 42.86%. The injured parts were mainly lower limbs,with 7 720 cases accounting for 34.32%. Most old fall cases were moderately injured,with 14 223 cases accounting for 63.23%. The difference in the severity of fall among different genders was statistically significant（P<0.05）. Conclusion Fall cases among the elderly in Jiaxing have an increasing trend. Senior age and women are risk factors. Fall mainly results in fractures in lower limbs.

OBJECTIVETo evaluate the sensitivity and specificity of optimized sequential screening program of colorectal cancer, and provide evidence for the further optimization of colorectal cancer screening program.

METHODSUsing cluster sampling method, 4 administrative villages were selected from Jiashan county as a census district in 2011 to 2013. Volunteers of 40 to 74 years old in the census were recruited, and tested by both optimized sequential screening (including questionnaire survey and fecal occult blood test) and colonoscopy for colorectal cancer. Sensitivity and specificity of different screening methods were calculated, respectively.

RESULTSA total of 2 607 volunteers took both simultaneously screening and colonoscopy at the same time. 20 colorectal cancer cases, 85 advanced adenoma cases, 271 non-advanced adenomas cases, and 141 non-adenomatous polyps cases were detected. Sensitivity of optimized sequential screening for colorectal cancer, advanced adenomas, and non-advanced adenomas were 70.0% (14/20) , 57.6% (49/85) and 36.5% (99/271) , specificity was 68.7% (1 776/2 587) , 69.2% (1 746/2 522) and 68.9% (1 610/2 336) , respectively. Sensitivity of the fecal occult blood test of colorectal cancer, advanced adenomas and non-advanced adenomas were 70.0% (14/20) , 47.1% (40/85) and 26.6% (72/271), specificity was 79.4% (2 053/2 587), 79.9% (2 014/2 522) and 79.6% (1 860/2 336). The sensitivity of fecal occult blood test and those of optimized sequential screening for colorectal cancer, advanced adenomas was not significant (χ(2) = 0.00, 1.91, all P values > 0.05). Sensitivity of questionnaire survey of colorectal cancer, advanced adenomas and non-advanced adenomas were 10.0% (2/20), 14.1% (12/85), 12.9% (35/271), specificity was 87.6% (2 266/2 587), 87.7% (2 211/2 522), 87.6% (2 046/2 336). There were no significant difference between non-advanced adenomas. The sensitivity of advanced adenomas and non-advanced adenomas showed no significant decline when the following six term were removed from screening programs: chronic diarrhea, chronic constipation, mucus or bloody history, history of chronic appendicitis or appendectomy surgery, chronic cholecystitis or gallbladder surgery, adverse events in the history of life, while the sensitivity of colorectal cancer remained nearly the same 70.0% (14/20), 52.9% (45/85), 31.4% (85/271) (χ(2) = 0.38, 1.61, all P values > 0.05).

CONCLUSIONCurrent optimized sequential screening programs for colorectal cancer in China have a high sensitivity and specificity. However, further optimization is viable and necessary.

Adenoma ; China ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Early Detection of Cancer ; Humans ; Mass Screening ; Occult Blood ; Sensitivity and Specificity ; Surveys and Questionnaires

The aim of this paper was to study the effect and mechanism of alcohol extract from Polygonum cuspidatum(PCE) on acute gouty arthritis in C57 BL/6 mice through NLRP3/ASC/caspase-1 axis. The model mice which injected with ankle joint injection of sodium urate crystals(MSU) were orally administrated with three different concentration of PCE, with colchicine as positive control. HE staining was used for observing the morphological changes of synovial tissue; concentration of IL-1β, IL-6 and TNF-α secreted by synovial tissue of the ankle joint were detected by ELISA; mRNA and protein expression of NLRP3, ASC and caspase-1 in synovial tissue were detected by RT-PCR and Western blot respectively. The results showed that the swelling degree of ankle joint in model mice were significantly elevated; expression of IL-1β, IL-6 and TNF-α were significantly increased; mRNA and protein expression of NLRP3, ASC and caspase-1 also significant increase, compared with normal control group. The swelling degree of ankle joint significantly relief; expression of IL-1β, IL-6 and TNF-α in joint synovium significantly decrease; mRNA and protein expression of NLRP3, ASC and caspase-1 were significantly decrease in PCE treatment group compared with model group. Our research implied that alcohol extract from P. cuspidatum had positive effect on acute gouty arthritis in mice, and the regulation of NLRP3/ASC/caspase-1 axis may be its mechanism.
Animals ; Ankle Joint ; physiopathology ; Arthritis, Gouty ; drug therapy ; CARD Signaling Adaptor Proteins ; metabolism ; Caspase 1 ; metabolism ; Fallopia japonica ; chemistry ; Interleukin-1beta ; metabolism ; Interleukin-6 ; metabolism ; Mice ; Mice, Inbred C57BL ; NLR Family, Pyrin Domain-Containing 3 Protein ; metabolism ; Plant Extracts ; pharmacology ; Tumor Necrosis Factor-alpha ; metabolism ; Uric Acid

Objective: To investigate the efficacy of pharmacist intervention in perioperative prophylactic application of antibiotics. Methods: From August 2017 to August 2018, 148 cases received surgery in Zhejiang Rongjun Hospital were selected, using odd-even grouping method, the patients were divided into two groups, with 74 cases in each group.The control group used antibacterial drugs without pharmacists intervention, the observation group used antibacterial drugs through pharmacists intervention.The use of antimicrobial agents was compared between the two groups. Results: The duration of prophylactic medication, the duration of hospitalization in the observation group were (2.59±0.24)d, (8.47±0.83)d, respectively, which in the control group were (3.76±0.36)d, (10.74±1.32)d, respectively, the differences between the two groups were statistically significant(t=23.262, 12.523, all P<0.01). The total cost of antibacterial drugs and the total drug cost in the observation group were (778.62±76.35)CNY, (3 036.75±302.11)CNY, respectively, which in the control group were (1 063.26±105.32)CNY, (4 698.64±1 452.28)CNY, respectively, and the differences between the two groups were statistically significant(t=18.823, 9.638, all P<0.01). The antibacterial drug use satisfaction of the observation group was 97.30%(72/74), which of the control group was 74.32%(55/74), the difference between the two groups was statistically significant(χ²=16.038, P<0.01). Conclusion The rational use of antibiotics can be promoted by pharmacist intervention in perioperative prophylaxis patients.

Objective: To explore the effect of 3D-slicer assisted soft channel drainage on the surgical outcome and prognosis of patients with hypertensive cerebral hemorrhage (HICH). Methods: Seventy-six HICH patients treated in Zhejiang Xin'an International Hospital from January 2016 to December 2018 were randomly divided into the control group and the observation group, with 38 cases in each group. Both groups of patients underwent percutaneous cone cranial soft channel drainage.The control group patients used CT hematoma localization, and the observation group patients used 3D-slicer software hematoma localization. The perioperative related data, surgical results, complications and prognosis of patients in the two groups were observed and compared. Results: The operation time and hospitalization time of patients in observation group were (76.24 ± 11.24) min and (15.21 ± 4.01) d, significantly shorter than those in control group [(103.17 ± 17.43) min and (18.63 ± 4.75) d], and there were significant differences (P < 0.05). The blood loss during operation and hematoma residual amount 7 d after operation in observation group were (77.21 ± 11.35) ml and (4.24 ± 0.87) ml, significantly lower than those in control group [(115.35 ± 21.22) ml and (18.63 ± 4.75) ml], and there were significant differences (P < 0.05). The hematoma clearance of patients 1 d and 3 d after operation in observation group were (83.24 ± 11.21) ml and (92.24 ± 15.63) ml, significantly higher than those in control group [(69.67 ± 10.73) ml and (85.57 ± 13.11) ml], and there were significant differences (P < 0.05). The incidence rates of intracranial rebleeding, intracranial infection and pulmonary infection in observation group were significantly lower than those in control group [2.63%(1/38) vs. 21.05%(8/38), 0 vs. 15.79% (6/38), 2.63%(1/38) vs. 21.05%(8/38)](P < 0.05). After treatment for 3 months, the good prognosis rate in observation group was significantly higher than that in control group [86.84%(33/38) vs. 65.79% (25/38)] (P < 0.05). Conclusions 3D-slicer software based on percutaneous soft-channel puncture and drainage for HICH patients can achieve better surgical results, reduce the incidence of complications and improve the prognosis of patients.