Recurrent miscarriage is a common disease in clinical obstetrics and gynecology. There is no curative treatment for recurrent miscarriage in conventional medicine. Traditional Chinese medicine (TCM) has been widely used in the treatment of recurrent miscarriage in China for thousands of years. However, randomized controlled trials (RCTs) with high quality evaluating the effectiveness and safety of Chinese herbal medicine (CHM) still lack. This study was conducted in order to identify methodological problems in published or unpublished RCTs of CHM in the treatment of recurrent miscarriage, and provide suggestions for TCM researchers to conduct high-quality clinical research.

Objective To evaluate the effects of exercise therapy in the treatment of hemiplegia following cerebral hemorrhage. Methods Activities of daily living(ADL) scoring and Fugl Meyer test were performed in 46 patients with hemiplegia following cerebral hemorrhage undergoing exercise therapy before and after treatment. Results Significant improvement of ADL, upper extremity function, and balance and walking abilities was found after treatment( P

Objective To observe and scale knee joint space of the patients who suffered adults' Kaschin-Beck disease (KBD) in Shangzhi City of Heilongjiang Province in order to acquire basic knowledge for upcoming intervention trial. Methods Clinical test was proceeded in adults aged above 40 in Guanghui Village of Shangzhi City in 2007. In typical patients, bilateral knee X-ray was taken and knee joint space was scaled. Three points were chosen on inner and outer epicondyle of each knee and results were recorded. Results There were 307 peoples over the age of 40 in the village. Two hundred eighty-two accepted clinical test, in a rate of 91.9%. Eighty out of 282 suffered KBD, accounting for 28.4%. When the patients' condition became more serious, measurements from flank, middle, inside points on outer epicondyle of joint space presented a narrowing trend [degree Ⅰ: (5.85±0.17), (4.84±0.17), (4.36±0.18)mm; degree Ⅱ: (5.11±0.43), (4.24±0.34), (3.48±0.28)nun; degree Ⅲ: (3.59± 0.78), (3.10±0.56), (2.14±0.62)mm; Fflank,middle,inside= 6.547,5.372,10.302, all P < 0.05], but those on inner epicondyle of joint space did not[degree Ⅰ:(3.66±0.17), (3.47±0.17), (3.73±0.18)mm; degree Ⅱ:(3.55± 0.34), (3.54±0.29), (4.35±0.35)mm; degree Ⅲ: (3.19±0.72), (3.92±0.66), (4.51±0.72)ram; Finside,middle,flank= 0.351,0.356,1.883, all P > 0.05]. Joint space < 5.00 mm were found in 618, among which 363 were measured on inner epieondyle, obviously greater than those measured on outer epicondyle of joint space(255), the difference being statistically signifieant(χ2=9.59, P<0.05). Conclusions Adult cases of KBD occur in Guanghui Village. Knee joint space of adult patients narrows obviously, the more serious, the narrower, especially occurring more obviously on outer epicondyle, but frequently on inner epicondyle.

Objective To investigate the efficacies of laparoscopic sleeve gastrectomy + duodenojejunal bypass (DJB) and laparoscopic gastric bypass in the treatment of patients with non-obese type 2 diabetes mellitus (T2DM).Methods The clinical data of 42 patients with type 2 diabetes mellitus and body mass index (BMI) ＜ 30 kg/m2 received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2012 to June 2013 were retrospectively analyzed.Fifteen patients received laparoscopic sleeve gastrectomy + DJB (Sleeve + DJB group),and 27 received Roux-en-Y gastric bypass (RYGB group).The follow-up time for all the patients was more than 6 months.The decrease of BMI,complete remission of T2DM,decrease of fasting glycemia and glycosylated hemoglobin (HbAlc),postoperative nutritional condition and the incidence of complications of the 2 groups were compared.The measurement data were analyzed using the t test and the repeated measurement chi-square test.Results The operation time of the Sleeve + DJB group and the RYGB group were (137 ± 61)minutes and (89 ± 43) minutes,with significant difference between the 2 groups (t =6.158,P ＜ 0.05).No mortality and hemorrhage,bowel obstruction and anastomotic stenosis were detected.One patient was complicated with bile leakage in the Sleeve + DJB group,and was cured by conservative treatment 5 days later.The levels of fasting glucose before operation and at postoperative month 1,3,6 were (8.9 ± 0.7) mmol/L,(5.8 ± 1.3) mmoL/L,(5.6 ±1.8) mmol/L and (5.7 ± 0.3) mmol/L in the Sleeve + DJB group,and (9.9 ± 1.2) mmol/L,(6.9 ± 0.8) mmol/L,(6.6 ± 2.2) mmol/L and (5.6 ± 0.8) mmol/L,with no significant difference between the 2 groups (F =1.670,2.932,0.444,0.158,P ＞ 0.05).The levels of HbAle before operation and at postoperative months 1,3,6 were 7.4％± 1.4％,6.5％ ±0.6％,5.7％±0.5％,5.9％ ±0.6％ in the Sleeve + DJB group,and 7.7％± 2.0％,6.8％ ± 1.3％,5.7％±0.8％,5.6％ ± 1.1％ in the RYGB group,with no significant difference between the 2 groups (F =0.055,0.125,0.005,0.286,P ＞ 0.05).The remission rates of T2DM of the Sleeve + DJB group and the RYGB group were 14/15 and 74.1％ (20/27) at postoperative month 6,with no significant difference between the 2 groups (x2 =2.320,P ＞ 0.05).The decrease rate of BMI of the Sleeve + DJB group and the RYGB group were 18.2％±9.5％ and 21.2％ ± 4.9％,with no significant difference between the 2 groups (t =0.982,P ＞0.05).The numbers of patients with postoperative anaemia,avitaminosis and diarrhea were 0,0,2 in the Sleeve + DJB group and 3,2,6 in the RYGB group,with no significant difference between the 2 groups (x2=1.795,1.167,0.908,P ＞0.05).The BMIs of all the patients were above 19 kg/m2.Conclusion The effects and incidence of postoperative complications of Sleeve + DJB for the treatment of T2DM are comparable to those of RYGB.Sleeve + DJB has less interference on the nutritional condition of patients compared with RYGB.

Objective To observe the security and efficacy of sevoflurane inhalation in combination with remifentanil controlled hypotension in patients undergoing functional endoscopic sinus surgery.Methods Forty pa tients undergoing elective functional endoscopic sinus surgery were randomly divided into propofol group (group P)and sevoflurane group(group S).In group P,patients received remifentanil 0.2μg · kg-1 · min-1 and propofol 4 ～6mg · kg-1 · min-1 intravenously,those in group S received remifentanil 0.2pg · kg-1 · min-1 and continuous inhalation of sevoflurane 2 ～ 3％,the end-tidal concentration was 1.1 ～ 1.7MAC.MAP was retained at 65 ～ 75 mmHg in the two groups.MAP and HR were recorded before controlled hypotension (T1),5min after controlled hypotension (T2),30min after controlled hypotension(T3),the termination of surgery(T4) and 5min after the termination of surgery(T5).Record the patient opening eyes time,wake extubation time,duration of surgery,blood loss.Also observed with or without respiratory depression,drowsiness,restlessness,nausea,vomiting and other adverse reactions.The same surgery fell surgical field quality rating according to Fromme operative field score table.Results Compared with T1,MAP(F =73.68) and HR(F =24.60) decreased significantly(P ＜ 0.05) at the other time points.There was no statistically significant difference in MAP(t =0.90) and HR(t =1.00) at the same time points between the two groups (P ＞ 0.05).Extubation time (t =0.44),duration of operation (t =1.23),operative field score (t =0:43) and blood loss (t =0.58) has no significant differences (P ＞ 0.05).Conclusion Inhalation hypotension by sevoflurane is feasible and safe in the functional endoscopic sinus surgery.It shows good quality of surgical field and less adverse reactions.

Aged ; Antigens, CD20 ; metabolism ; Humans ; Leukocyte Common Antigens ; metabolism ; Lymphoma, B-Cell ; complications ; metabolism ; pathology ; surgery ; Male ; Prostate ; pathology ; Prostatectomy ; Prostatic Hyperplasia ; complications ; metabolism ; pathology ; surgery

Animals ; Glutathione ; therapeutic use ; Guanidines ; therapeutic use ; Ischemic Postconditioning ; methods ; Male ; Myocardial Reperfusion Injury ; physiopathology ; prevention & control ; Random Allocation ; Rats ; Rats, Wistar ; Sodium-Hydrogen Exchangers ; antagonists & inhibitors ; Sulfones ; therapeutic use

Adolescent ; Adult ; Anemia, Hemolytic, Autoimmune ; drug therapy ; Female ; Humans ; Immunosuppressive Agents ; therapeutic use ; Male ; Middle Aged ; Sirolimus ; therapeutic use ; Treatment Outcome ; Young Adult

Objective To explore the standardized procedures of laparoscopic sleeve gastrectomy (LSG).Methods The clinical data of 153 patients with obesity who underwent LSG at the First Affiliated Hospital of Nanjing Medical University from December 2010 to December 2014 were retrospectively analyzed.All the 153 patients were divided into 3 groups:22 patients in the first stage group were admitted to the hospital from December 2010 to September 2011,57 patients in the second stage group were admitted to the hospital from October 2011 to December 2013 and 74 patients in the third stage group were admitted to the hospital from January 2014 to December 2014.In the first stage group,1.1 cm gastroscope in diameter was introduced into the pylorus as a support,great curve of stomach with 5 cm distances from the pylorus was cut using a green cartridge,and then blue cartridges were used at the body and fundus of stomach.The 3-0 vicryl continuous and whole-layer suture was performed.The routine abdominal drainage was ended at postoperative hour 24 without the gastric tube placement.In the second stage group,36 Fr bougie tube was placed at the gastric antrum,cutting at the proximal 5 cm from pylorus was performed using a green cartridge,and then blue cartridges were used.The 3-0 Vicryl interrupted and wholelayer suture was performed at the reinforcement of staple lines,and no drainage tube was placed.In the third stage group,36 Fr bougie tube was placed at the gastric antrum,cutting at the proximal 3 cm from pylorus was performed using two green cartridges,and then blue cartridges were used.The 3-0 vicryl continuous and whole-layer suture was performed at the reinforcement of staple lines,and no drainage tube was placed.Other common perioperative management included as follows:free greater omentum was done by the supersonic knife.Patients had outof-bed activity after waking up and intake of water and fluid diet at postoperative hour 6-8,including oral liquid diet of 300-500 mL at postoperative hour 24 and 500-1 000 mL at postoperative hour 48.Patients were followed up till May 2015,and return visit at postoperative month 1,3,6,9 and 12 within 1 year and once every 6 months after postoperative year 2.The operation time,volume of intraoperative blood loss,duration of hospital stay and excess weight loss (EWL) percentage were analyzed.Comparison of count data was analyzed by the chi-square test.Measurement data with normal distribution were presented as-x± s.Comparisons among groups were evaluated with the one-way ANOVA and chi-square test.Results All the patients received successfully LSG without conversion to open surgery,perioperative reoperation and death.Four patients were complicated with intraoperative injury,including 3 patients with liver injury and 1 patient with hepatic round ligament injury.No intraoperative and postoperative hemorrhea,postoperative gastric leakage and obstruction were detected.The operation time,volume of intraoperative blood loss,duration of hospital stay and 1-year EWL were (91 ± 31) minutes,(51 ± 33) mL,(4.1 ± 3.4) days,67％ ± 12％ in the first stage group,(56 ± 27) minutes,(24 ± 20) mL,(3.1 ± 2.7) days,65 ％ ± 14％ in the second stage group and (54 ± 18) minutes,(21 ± 20) mL,(3.0 ± 2.1) days,68％ ± 24％ in the third stage group,respectively.There were significant differences in the operation time and intraoperative volume of blood loss among the 3 groups (F =7.471,6.037,P ＜0.05).There was no significant difference in the duration of hospital stay and 1-year EWL among the 3 groups (F =1.439,2.296,P ＞ 0.05).All the patients were followed up.Nineteen patients with sleep apnea had complete remission of symptoms at postoperative month 3.Twenty-one patients with polycystic ovary syndrome had remission of symptoms after operations.Of 27 patients with type 2 diabetes mellitus,25 patients had remission of symptoms at postoperative year 1 and 2 patients had improvement of symptoms.Fifty-seven of 79 patients with lipid metabolism disorders returned to normal at postopera tive year 1.One hundred and twelve patients with fatty liver were improved after operation.Conclusions LSG is safe and feasible with a standardized operative procedure.Whole-layer suture may be prevent the leakage and no placement of gastric tube and drainage tube after operation can reduce the incidence of complications.

Objective To explore the clinical effects of metabolic surgery on obese adolescents.Methods The clinical data of 28 obese adolescents who were admitted to the First Affiliated Hospital of Nanjing Medical University from June 2010 to January 2014 were retrospectively analyzed.Patients underwent gastric bypass and sleeve gastrectomy according to their own intention and were followed up regularly at 1,3,6,9 months after surgery till October 2014.The perioperative conditions and postoperative effecacies of patients were observed.The measurement data with normal distribution were presented as-x ± s,the comparisons of weight-loss trends among different surgeries were analyzed by the repeated measures ANOVA.Results All surgeries were performed under laparoscope without severe complications or deaths,including 16 cases of gastric bypass and 12 cases of sleeve gastrectomy.The median operation time and duration of postoperative stay were 136.5 minutes (range,60.0-320.0 minutes) and 4 days (range,2-8 days),respectively.Three patients had perioperative complications.All patients received postoperative follow-ups.The median body mass index(BMI) at postoperative month 1,3,6,9 were 36.1 kg/m2,33.2 kg/m2,30.2 kg/m2 and 28.4 kg/m2,and mean excess weight loss (EWL) rate were 24.6％,40.4％,55.1％ and 63.9％.The BMIs before operation and at postoperative month 1,3,6,9 were (43 ± 6) kg/m2,(37 ± 5) kg/m2,(34 ± 4) kg/m2,(30 ± 4) kg/m2 and (29 ± 4) kg/m2 in patients undergoing gastric bypass,and (39±4)kg/m2,(35±4)kg/m2,(32 ±5)kg/m2,(31 ±4)kg/m2 and (28 ±4)kg/m2 in patients undergoing sleeve gastrectomy,respectively.The EWL at postoperative month 1,3,6,9 were 24％ ± 9％,40％±9％,59％ ± 12％ and 65％ ± 12％ in patients undergoing gastric bypass,and 25％ ±9％,41％ ± 15％,49％ ± 16％ and 63％ ± 17％ in patients undergoing sleeve gastrectomy,respectively.There was no difference in the change of BMI and EWL between gastric bypass and sleeve gastrectomy (F =0.777,0.332,P ＞ 0.05).Four patients undergoing gastric bypass were found to have nutritional complications in follow-up and recovered after symptomatic treatment.Concltsion Bariatric surgery is safe and feasible for obese adolescents with a significant weight loss.However relevant nutrition complications may occur,it is significant to sustain a long-term followup and nutrition intervention,and the choice of surgical procedures should follow the principle of individuation.