As a new kind of perioperative management strategy and ideas,enhanced recovery after surgery (ERAS) brings a series of traditional perioperative treatment measures for optimization based on evidence-based medicine.Its primary aim is to decrease surgery-related stress,complications,and also to facilitate recovery with multimodal treatments.The ERAS pathway has been widely applied and proved to be efficient in gastrointestinal,colorectal,orthopedic,thoracic and gynecological surgery.Owing to the complexity of surgical procedure,long operation time and high perioperative complication rate in liver transplantation compared with other surgeries.This new concept has not been widely accepted or recommended in liver transplantation,although some previous studies have validated its safety and effectiveness.This paper overviewed the recent literature on the specific procedures,efficacy,safety and development of ERAS applied in liver transplantation.

Aim To study the effect of polysaccharides from Gastrodia elata Blume(GEP) on levels of superoxide dismutase(SOD),malondialdehyde(MDA) and nitric oxide(NO);and the retinal morphology after rat retina ischemia reperfusion injury.Method Retinal ischemia was induced in SD rats by increasing the intraocular pressure to 16 kPa for 60 min via cannulation into the anterior chamber.SD rats were divided into five groups randomly: Small dose GEP group,Middle dose GEP group,Large dose GEP group,Vitamin E group and Negative contral group.At 60 min,24 h and 72 h after ischemia reperfusion,levels of SOD,MDA and NO in rat retinas were measured,and histopathologic changes were observed.Results At 60 min,24 h and 72 h after ischemia reperfusion,levels of SOD in rat retinas in middle,large dose GEP groups were significantly higher than that in negative control group(P

[Objective]To compare the clinical outcomes of fresh embryo transfer of the in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in different age groups as well as in different responders using gonadotropin-re-leasing hormone agonist(GnRH-a)long protocol or GnRH antagonist(GnRH-ant)protocol.[Methods]A retrospective analysis was performed on 737 IVF/ICSI cycles,including 386 cycles of GnRH-a long protocol(group A)and 351 cycles of GnRH-ant protocol (group B),from August 28,2015 to December 31,2016. Then all the cycles were divided into sub-groups by ages and retrieved oo-cyte numbers:group a1(<38 years),group a2(≥38 years);group b1(n≤5),group b2(6≤n≤15),group b3(n>15). The basic information of patients and clinical outcomes were compared.[Results](1)Comparable results were obtained from group A and group B in these following variables such as fertilization rate,normal fertilization rate,biochemical pregnancy rate and miscarriage rage. But the stimulation period,the total gonadotropin(Gn)dosage,estradiol(E2)level and endometrial thickness on the day of human chorionic gonadotropin(hCG)administration,number of oocytes retrieved and mature oocytes,ovarian hyperstimulation syn-drome(OHSS)rate,implantation rate and clinical pregnancy rate were significantly higher in group A than group B(P<0.05),and significantly higher cancellation rate of fresh embryo transfer was observed in group B(P<0.001).(2)When divided by ages,no mat-ter in sub-group a1 or sub-group a2,the implantation rate was slightly lower in GnRH-ant protocol than in GnRH-a long protocol, although they failed to reach significant difference(sub-group a1:32.6%vs 39.8%,P=0.067;sub-group a2:9.7%vs 17.9%,P=0.066). The clinical pregnancy rate was comparable using these two protocols in sub-group a1(54.8%vs 50.4%,P=0.429),but it was significantly lower by using GnRH-ant protocol than GnRH-a long protocol in sub-group a2(19.6%vs 39.1%,P=0.021).(3) When divided by numbers of oocytes retrieved,the implantation rate was significantly lower when using GnRH-ant protocol in sub-group b1(13.1%vs 26.0%,P=0.026),but we failed to observe significant differences in other two sub-groups. The clinical preg-nancy rates were comparable in all sub-groups ,whereas differed considerably in sub-group b1 (36.6% vs 19.3%,P = 0.056).[Conclusion]Overall,the implantation rate and clinical pregnancy rate were higher in GnRH-a long protocol than those in GnRH-ant protocol. Nevertheless,GnRH-ant protocol could reduce the dosage of Gn,shorten the treatment duration,and effectively reduce the occurrence of OHSS. There were similar pregnancy outcomes in two protocols for normal responders and high responders ,while for advanced patients or other poor responders,the implantation rate and clinical pregnancy rate were higher in GnRH-a protocol.

Objective:To explore the safety of cyclophosphamide combined with taxane chemotherapy in triple-negative breast cancer patients with chronic renal failure and the management strategy of complications.Methods:Data of 8 patients with triple-negative breast cancer and chronic renal failure admitted to our hospital from Jun 2016 to Dec 2019 were retrospectively analyzed.Results:Eight patients received standard cyclophosphamide combined with taxane (TC regimen) chemotherapy after operation, 5 of which received docetaxel 75 mg/m 2 + cyclophosphamide 600 mg/m 2, and 3 received albumin paclitaxel 260 mg/m 2+ cyclophosphamide 600 mg/m 2, during chemotherapy, only leukopenia, hair loss and gastrointestinal reactions occurred in grades 3 to 4, and the incidence was 25%, 25% and 12%, respectively. Four patients adjusted the dosage due to adverse reactions. One patient quit, the remaining patients successfully completed 4 cycles of chemotherapy. The average serum creatinine before chemotherapy was (498±63) μmol/L, and after chemotherapy, it was (518±61) μmol/L ( t=-2.335, P>0.05). Conclusions:Combined with chronic renal failure is not a contraindication to postoperative chemotherapy for patients with breast cancer. It is safe to choose standard TC regimen and adjust the dose of adjuvant chemotherapy for patients with triple-negative breast cancer.

Objective To evaluate the efficiency and safety of exercise interventions on cancer related fatigue. Methods Cochrane Library, JBI Database of Systematic Reviews, MEDLINE, EMbase, CINAHL, Chinese Journal Full- text Database, Chinese Biomedical Literature Database, and Wanfang Databse were searched from the inception to November 2014 to screen the systematic review and Meta-analysis conforming to the inclusion criteria. Two authors independently appraised their methodological qualities with Overview Quality Assessment Questionnaire (OQAQ), and analyzed the data using descriptive analysis. The primary outcome included the scaling of cancer related fatigue, the secondary outcome included adherence to exercise intervention and the incidence of adverse events. Results Fourteen systematic review/Meta-analysis were identified, twelve of them had a high methodological quality (Scoring 5-7). Six systematic review/Meta-analysis found that aerobic exercise could effectively alleviate cancer related fatigue, especially for breast cancer patients;seven articles showed that exercise could modulate cancer related fatigue of patients under active treatments;seven articles reported the compliance to the exercise intervention, four articles reported adverse events occurring during the intervention, very few of them resulted directly from the exercise intervention. Conclusions Exercise intervention can modulate cancer related fatigue with good safety.

OBJECTIVE:To prepare the sterilized medical bone wax and to establish the standard of quality control.METHODS:The bone wax was identified with chemical approach and the quality of bone wax was evaluated by saponification value.RESULTS:The bone wax was appropriate in formula,feasible in preparing technique and satisfactory in therapeutic efficacy with a satisfication rate of 98%.CONCLUSION:There are no obvious differences between the bone wax developed by our hospital and imported bone wax in quality,therefore the prepared bone wax can take the place of imported products.

Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been gradually developing and has replaced the percutaneous transhepatic bile duct drainagebecause of its safety and effectiveness, and it has become an effective alternative plan after endoscopic retrograde cholangiopancreatography treatment failure in patients with benign and malignant biliary obstruction. In clinical operation, the surgeons can choose the appropriate surgical method according to the patient's own condition and anatomical characteristics. This paper summarized the clinical application and research progress of EUS-BD technology by collecting relevant literatures published in recent years.

In recent years, 125I radioactive seed implantation has been greatly developed for the treatment of unresectable pancreatic cancer, and clinical practice shows that it has good therapeutic effects in relieving pain, controlling local tumor progression, and prolonging patients′ survival time. This article introduces the physical and biological features of 125I radioactive seeds and the advantages and disadvantages of implantation, as well as the therapeutic method, surgical safety, and clinical effects of 125I radioactive seed implantation in the treatment of unresectable pancreatic cancer. This article points out that it is an effective therapeutic method and should be widely applied in well-equipped hospitals.

Objective:To analyze the expression of targeting protein for Xklp2 (TPX2) in kidney renal clear cell carcinoma (KIRC) and its clinical significance.Methods:The postoperative tissue samples of 54 patients with KIRC admitted to the Department of Urology, the First Affiliated Hospital of Bengbu Medical College from July 2017 to June 2019 were collected. Immunohistochemistry was used to detect the protein expression of TPX2 in renal carcinoma and paracancerous tissues. The difference of TPX2 mRNA expression between KIRC tissues and normal tissues was analyzed by using the TIMER database, which verified the immunohistochemical results. The UALCAN database and the Kaplan-Meier plotter database were used to analyze the relationship between TPX2 mRNA expression and clinical stage, molecular subtypes, lymph node metastasis, and prognosis of patients with KIRC. The protein interaction network was constructed by STRING database to obtain TPX2-related proteins, and the genes corresponding to the related proteins were enriched for the KEGG pathway. The relationship between TPX2 expression and immune cell infiltration and the immune checkpoint was studied by using the TIMER database.Results:Immunohistochemical results showed that the positive expression rate of TPX2 protein was 48.15% (26/54) in cancer tissues, which was higher than that in paracancerous tissues (20.37%, 11/54) ( χ2=9.25, P=0.002). The results of bioinformatics analysis showed that TPX2 mRNA expression was significantly up-regulated in KIRC [cancer tissue: 1.89 (1.49, 2.42), normal tissue: 0.35 (0.24, 0.57), U=2 297.00, P<0.001]. The expression of TPX2 mRNA was related to the clinical stage ( χ2=34.36, P<0.001), molecular subtypes ( χ2=30.15, P<0.001), and lymph node metastasis status ( χ2=27.21, P<0.001) of KIRC patients. The 5-year survival rate (53.80%) in patients with high TPX2 expression was lower than that in patients with low TPX2 expression (74.40%, χ2=18.87, P<0.001). STRING database protein interaction network construction obtained 20 TPX2-related proteins, and the genes corresponding to the related proteins were enriched in the cell cycle. The expression of TPX2 was positively correlated with B cells ( r=0.30, P<0.001), CD8 + T cells ( r=0.23, P<0.001), CD4 + T cells ( r=0.18, P<0.001), macrophages ( r=0.20, P<0.001), neutrophils ( r=0.31, P<0.001), dendritic cells ( r=0.39, P<0.001) infiltration and most of its biomarkers (all P<0.05). It was positively correlated with immune checkpoint PD-1 ( r=0.31, P<0.001) and CTLA-4 ( r=0.27, P<0.001), but not correlated with PD-L1 ( r=0.07, P=0.146) . Conclusion:TPX2 is highly expressed in KIRC and is closely associated with poor prognosis. It is expected to be a new therapeutic target for KIRC.

Objective:To investigate the clinical epidemiological data of children with prolonged mechanical ventilation (PMV) in pediatric intensive care unit(PICU), and analyze the primary disease of children with PMV as well as the disease characteristics and prognosis of children with PMV under different kinds of primary disease.Methods:The clinical data of hospitalized children with PMV in PICU at Children′s Hospital of Fudan University from January 2019 to December 2020 were retrospectively collected.Results:A total of 46 children with PMV were collected.There were 18 males (39.1%) and 28 females (60.9%). The median age was 37 (8, 86) months and the median body weight was 15 (7, 20) kg.The average pediatric critical illness score at admission was 84.2±7.7, PaO 2/FiO 2 was (245.5±99.8)mmHg.The primary diseases leading to PMV were as follows: there were 14 cases of severe pneumonia, eight cases of severe encephalitis, five cases of bronchopulmonary dysplasia, three cases of upper airway obstruction/craniofacial deformity, three cases of myasthenia, three cases of brain stem tumor, three cases of mitochondrial encephalomyopathy, two cases of spinal muscular atrophy, two cases of Prader-Willi syndrome, one case of dermatomyositis, one case of severe brain injury, and one case of central hypoventilation.The causes of unable to withdraw ventilator were respiratory dysfunction in 24 cases, brain dysfunction in 16 cases, and diaphragm dysfunction in six cases.Compared with neuromuscular diseases, children with PMV caused by respiratory diseases had lower month age, higher preterm birth rate, lower PaO 2/FiO 2 ratio, higher parameters for ventilator treatment, and the differences were statistically significant ( P<0.05). Children with PMV caused by neuromuscular diseases had lower Glasgow coma score and higher coma rate, and the differences were statistically significant ( P<0.05). A total of nine (19.6%) cases underwent tracheotomy.A total of 23 (50.0%) cases were successfully extubated from ventilator, six (13.0%) cases were dependent on invasive ventilator, and six (13.0%) cases were breathing with tracheotomy tube.The median mechanical ventilation time was 33 (28, 40) days, the median PICU hospital stay was 42 (34, 56) days, and the median hospital stay was 51 (41, 65) days.A total of 27 (58.7%) cases were improved and discharged, four (8.7%) cases were transferred to rehabilitation hospital, four (8.7%) cases were transferred to local hospital, and 11 (23.9%) cases died in hospital or at home after giving up. Conclusion:The main causes of PMV in PICU children are respiratory dysfunction, brain dysfunction and diaphragm dysfunction.50.0% of the children with PMV could be discharged from the ventilator, and 23.9% died or died after giving up.