By sorting out the action and the application of Astragalus in the main works about Chinese herb during the different historical period, the experience that the physician had applied Astragalus could be known, the whole process that Astragalus had been applied from begin has been understood. Based on that study, its beneficial to reasonably apply Astragalus in the clinical application, further to deeply find and succeed the potential and the loosed action and the applied experience of Astragalus. That study provides the theory foundation for further expanding the applied scope of Astragalus, also presents a kind of train of thought for the research and develop of new Chinese herbs.

Objective To study whether Clonorchis sinensis eggs were involved in the pathogen esis of gallbladder stones.Method From March to August 2011,the gallbladder stones from 183 patients were studied using microscopic examination and FTIR spectroscopy.Twenty egg-positive and 20egg-negative gallbladder stones found under microscopic examination were chosen randomly and analyzed through real-time fluorescent PCR and scanning electron microscopy.Results Eggs were detected in 118 of 183 gallbladder stones.The eggs were preliminarily diagnosed as Clonorchis sinensis eggs using the morphologic characteristics under light microscope.The results of real-time fluorescent PCR showed eggs in the gallbladder stones were Clonorchis sinensis eggs.The 118 egg-positive gallbladder stones were composed of 97 pigment stones,21 mixed stones and no cholesterol stones.The detection rate of Clonorchis sinensis eggs in pigment stones were the highest among the three types of gallbladder stones (P＜0.001).The 20 egg-positive stones were observed by scanning electronic microscopy:dozens or even hundreds of Clonorchis sinensis eggs were visible under 400 times magnification; and a dozen or even dozens of Clonorchis sinensis eggs and the surrounding particles were adherent to or parceled with each other under 1000 times magnification.While under 3000 times magnification,uneven texture was seen on the surface of eggs with pieces being shed from some eggs.Some eggs were hollow or without cover.Most of them were adherent to or wrapped with amorphous particles or mucoid matter.Conclusions A large amount of Clonorchis sinensis eggs were detected in gallbladder stones.Clonorchis sinensis eggs were associated with the formation of gallbladder stones,especially with pig ment stones.

Objective A systematic study to classify mixed gallbladder stones to determine their relationship with Clonorchis sinensis infection.Methods 349 consecutive patients with mixed gallbladder stones were enrolled into this study and their gallstones were studied.The material composition of gallbladder stones was analyzed using Fourier Transform Infrared spectroscopy,and the distribution and microstructure of the material components were studied using Scanning Electron Microscopy.The composition and distribution of the elements were analyzed by an X-ray energy spectrometer.Gallbladder stones were classified accordingly,and the stones were then grinded for microscopic examination.The stones were divided into two groups based on the results of detection of clonorchis sinensis eggs.Patients were also divided into two groups according to the patients' region (high-incidence and low-incidence regions of Clonorchis sinensis infection).The diversity of the subtypes of mixed gallbladder stones was compared.Results 14 subtypes were found,including Bilirubinate-calcium carbonate mixed stones (n =134),Cholesterol-bilirubinate mixed stones (n =87),Bilirubinate-phosphate mixed stones (n =39),Cholesterol-calcium carbonate mixed stones (n =30),Cholesterol-bilirubinate-calcium carbonate mixed stones (n =15),etc.Bilirubinate-calcium carbonate mixed stones were the main subtype of egg-positive mixed gallbladder stones and the patients were from high-incidence regions.Cholesterol-bilirubinate mixed stones were the main subtype of egg-negative mixed gallbladder stones and patients were from low-incidence regions.The differences of the subtypes constituent between the high-incidence and low-incidence regions groups were significant (P ＜ 0.05),and between the egg-positive and egg-negative groups were also significant (P ＜ 0.05).Conclusions The most common subtypes of mixed gallbladder stones were bilirubinate-calcium carbonate mixed stones,while the second was cholesterol-bilirubinate mixed stones.Clonorchis sinensis infection was mainly associated with Bilirubinatecalcium carbonate mixed stones.

Background Clinical effectiveness of intavitreal injection of glucocorticosteroid for macular edema has been verified,especially triamcinolone acetonide(TA).However,the efficacy and safety of combination of TA with macular laser grid photocoagulation for macular edema is concerned. Objective This clinical trial was to evaluate the efficacy and safety of intravitreal injection of TA combined with macular laser grid photocoagulation in the treatment of macular edema. Methods A case-cohort study was designed.One hundred and twenty eyes of 120 patients with macular edema from diabetes or retinal vein occlusion were included in this study.The patients were randomized into trial group and control group,with the matched age,course,visual acuity,intraocular pressure (IOP).The patients of the trial group received intravitreal injection of TA combined with macular laser grid photocoagulation,and those of the control group were managed with macular laser grid photocoagulation only.Best corrected visual acuity ( BCVA),optical coherence tomography(OCT),fundus fluorescein angiography(FFA) and IOP were examined before TA injection and 1 week,1 month,3 months,6 months after treatment and compared among different time points between two groups.Written informed consent was obtained from each patient prior to entering this trial. Results Compared with TA injection before,the BCVA was significantly elevated in the trial group 1 week,1 month,3 months and 6 months after TA injection( all P=0.000),however,no obvious improvement of visual acuity was found in the control group before and after treatment at any time point (P＞0.05 ).At various time points,the visual acuity was significantly improved in the trial group than the control group (P =0.037,0.000,0.002,0.046 ).Macular thickness was significantly decreased at various time points after TA injection in comparison with before TA injection in the trial group(all P=0.000),but no significant change in macular thickness in the control group between before and after treatment at any time point( P＞0.05 ).Macular thickness was lower in the trial group compared with the control group at various time points after treatment ( P＜0.05 ).Recurrence of macular edema was seen in 7 eyes ( 1 1.67％ ) 4-6 months,and the IOP raise( ＞21 mmHg)was found in 11 eyes( 14.1％ )after TA injection in the trial group.Conclusions Intravitreal injection of TA combined with macular laser grid photocoagulation can be an effective method in the treatment of macular edema.However,recurrence of macular edema or increase of IOP may occur in a few patients within 6 months after TA injection.A long-term follow-up should be performed for the evaluation of efficacy and safety after intravitreous injection of TA.

ObjectiveTo investigate the relationship between intramural gallstones and intraluminal gallstones. MethodsIn this present study, the control study was applied to analysis on the gallstones from 116 cholecystolithiasis patients with intramural gallstones as well as intraluminal gallstones. All the patients were from the general surgery department and accepted gallbladder-preserving cholecystolithotomy during 2009.02-2009.08. Meanwhile, 171 patients with intraluminal gallstones were investigated the clinical traits; and gallstones from them were analyzed with FT-IR and microsopic examination. ResultsThe results showed the coincidence rate of stone type was 97.4％, and it was mainly pigment gallstones and mixed gallstones in 116 cases; the coincident detection rate of clonorchis sinensis eggs was 98.3 ％, and it was much higher in the pigment gallstones and mixed gallstones than that in the cholesterol gallstones. The ratio of pigment gallstones from the 116 patients group was higher than the 171 patients group, and the detection rate of C. sinensis eggs of the two groups had no statistical difference (P＞0.05). ConclusionsThe stone type of intramural gallstones was mainly pigment gallstones and mixed gallstones. Intramural gallstones and intraluminal gallstones were homologous.

Objective To develop a classification of gallbladder stones,to analyze the clinical characteristics of each type of stone and to provide a theoretical basis for the formation of different types of gallbladder stones.Method 925 consecutive patients with gallbladder stones were enrolled and their gallstones were studied.The material composition of the gallbladder stones was analyzed using fourier transform infrared spectroscopy and the distribution and microstructure of the material components were observed using scanning electron microscopy.The composition and distribution of the elements were analyzed by an X-ray energy spectrometer.Gallbladder stones were classified accordingly.Results The gallbladder stones were classified into 8 types and more than ten subtypes,including cholesterol stones (n =334),pigment stones (n =246),calcium carbonate stones (n =167),phosphate stones (n =14),calcium stearate stones (n =11),protein stones (n =3),cystine stones (n =1) and mixed stones (n =149).Mixed stones were those stones with two or more than two kinds of material components and the content of each component was similar.A total of 11 subtypes of mixed stones were found in this study.Conclusion The systematic classification of gallbladder stones indicated that different types of stones had different characteristics in terms of infrared spectrogram,microstructure,elemental composition and distribution,thus providing an important basis for the mechanistic study of gallbladder stones.

Objective To investigate the clinical value of bile reinfusion combined with enteral nutrition before R0 resection of hilar cholangiocarcinoma.Methods The clinical data of 46 patients with hilar cholangiocarcinoma who underwent R0 resection at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2010 to January 2014 were analyzed retrospectively.The clinical data of 21 patients (the experimental group) who received bile reinfusion by preoperative percutaneous transhepatic cholangiography and drainage (PTCD) combined with enteral nutrition with nasojejunal tube were compared with 25 patients (the control group) who received neither PTCD nor enteral nutrition.The differences in the clinical indicators between the 2 groups were analyzed.Results In the experimental group,the levels of ALT,AKP,TBil and DBil decreased significantly after PTCD as compared with the original levels (t =4.433,4.547,5.648,4.681,P ＜ 0.05).The operation time and blood loss in the experimental group was reduced significantly when compared with the control group (t =-2.810,-2.047,P ＜ 0.05).The volume of postoperative albumin transfusion and the postoperative hospitalization in the experimental group was significantly reduced when compared with the control group (t =-3.083,t =-3.083,P ＜ 0.05).Conclusion Bile reinfusion combined with enteral nutrition facilitated the recovery of preoperative hepatic function in patients who underwent R0 resection of hilar cholangiocarcinoma,thus improving the safety of surgery and facilitated postoperative rehabilitation.

Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in patients undergoing postoperative early enteral nutrition (EEN) with radical resection for hilar cholangiocarcinoma.Methods The clinical data of 48 patients with hilar cholangiocarcinoma who were admitted to the Drum Tower Clinical Medical College of Nanjing Medical University from July 2006 to September 2014 were retrospectively analyzed.All the 48 patients underwent radical resection for hilar cholangiocarcinoma,including 24 patients receiving postoperative EEN (EEN group) and 24 patients receiving total parenteral nutrition (TPN group).The serologic indices and liver function were detected regularly after operation.Ten percent of albumin (Alb) 10 g was administered by intravenous infusion when Alb ＜ 30 g/L.The indexes of all the 48 patients were compared in the 2 groups at postoperative day 3 and 7,including the serologic indices and liver function,the exhaust time,the volume of Alb infusion,the complications (incisional infection,abdominal infection,pleural effusion,peritoneal effusion and bile leakage) and the duration of hospital stay.The patients were followed up by outpatient examination and telephone interview till September 2014.The measurement data with normal distribution were presented as x ± s,comparison between groups and count data were analyzed using the t test and chi-squared test,respectively.Results Patients in the 2 groups were cured successfully and discharged,and no patient died perioperatively.Patients in the EEN group had a good tolerance for EEN and no occurrence of EEN-related complications was detected.The level of the GGT was (108 ± 73) U/L in the EEN group,which was significantly lower than (225 ± 121) U/L in the TPN group at postoperative day 3 (t =4.041,P ＜ 0.05).The level of the GGT was (142 ± 86) U/L in the EEN group,which was no significantly different from (183 ± 107)U/L in the TPN group at postoperative day 7 (t =1.477,P ＞ 0.05).The postoperative time to anal exsufflation and the duration of hospital stay were (73 ± 18) hours and (15 ± 4) days in the EEN group,which were significantly different from (97 ± 21) hours and (18 ± 4) days in the TPN group,and the volume of Alb infusion was (44 ± 29)g in the EEN group,which was significantly lower than (101 ± 92) g in the TPN group (t =4.295,2.615,2.916,P ＜ 0.05).All the 48 patients were followed up for 1 to 71 months (mediantime,10 months),no patients received reoperation or re-admitted to the hospital due to complications.Conclusion The application of postoperative EEN in enhanced recovery of patients undergoing radical resection for hilar cholangiocarcinoma is safe and effective,it could accelerate the recovery of enteral function,shorten the postoperative duration of hospital stay and reduce the supplement of extrinsic Alb,which is helpful for the fast recovery of patients.

Objective To Investigation the quality of marrow smear purchased by CDUTCM.Methods The quality and the typ-icality of marrow smears purchased during 2015 -2016 were collectively examined,and then decided whether these smears fit the blood cell morphology experimental teaching requirement.Results Of all the 960 marrow smears purchased these two years, 49.7% failed in smear made or stained,and 16.0% failed to meet the teaching requirements in the typicality of marrow cells.Con-clusion Teaching marrow smears,being different from clinic ones in their preparation and morphological diagnosis,must be of great quality in sustaining and of better typicality in their cell features.

Objective To study the relationship between Clonorchis sinensis infestation and different types of gallbladder stones.Methods From May 2011 to September 2014, 1 052 cases of gallbladder stones were collected from the Department of General Surgery at The Sixth People's Hospital of Nansha, Guangzhou.These stones were first grinded for microscopic examination and divided into two groups based on the results of detection of Clonorchis sinensis eggs.They were then analyzed by FTIR spectroscopy to identify the type of gallbladder stones.Some stones were also chosen randomly for observation under scanning electron microscope (SEM).Results Clonorchis sinensis eggs were found in 300 stones and among these, the number and proportion of cholesterol, bile pigment, calcium carbonate, mixed and other types of stones were 28 (9.3％), 102 (34.0％), 102 (34.0％), 50 (16.7％), and 18 (6.0％), respectively.In the 752 egg-negative stones, the number and proportion of the above five types of stones were 414 (55.1％), 132 (17.6％), 66 (8.8％), 94 (12.5％), and 46 (6.1％), respectively.Observation under SEM showed a lot of tiny particles were absorbed on the mesh of the superficial texture of the Clonorchis sinensis eggs, which were also adherent to the bilirubin particles, calcium stearate crystals, phosphate, calcium stearate and protein particles.Conclusions The main types of egg-positive stones were bile pigment and calcium carbonate stones, while cholesterol stone was the main type of egg-negative stones.Clonorchis sinensis infestation was associated mainly with bile pigment and calcium carbonate stones.