Objective To evaluate the clinical efficacy and safety of 1aparoscopy-assisted distal gastrectomy (LADG) for patients with advanced gastric cancer. Methods Clinical data of 198 cases with advanced gastric cancer were retrospectively analyzed. Based on the surgical approach, patients were divided into laparotomy group (n = 101) and laparoscopic group (n = 97), and the intraoperative situation, postoperative complications and quality of life were compared. Results There were no statistical differences in operation time [(226.30 ± 36.40) vs (220.50 ± 29.90) min, t = 1.23, P = 0.221)], number of lymph node cleaning [(22.01 ± 4.99) vs (20.69 ± 4.53), t = 1.95, P = 0.053] between the two groups; the blood loss of laparoscopy group was less than the laparotomy group [(114.50 ± 20.30) vs (168.30 ± 40.04) ml, t = 11.77, P = 0.000]; gastrointestinal function recovery time of laparoscopy group was less than laparotomy group [(72.30 ± 7.91) vs (84.05 ± 9.04) h, t = 9.72, P = 0.000); hospital stay of laparoscopy group was less than the laparotomy group [(8.89 ± 1.57) vs (10.36 ± 2.65) d, t = 4.72, P = 0.000]; there were no statistical differences in the tumor proximal cut end [(5.07 ± 2.04) vs (4.85 ± 1.98) cm, t = 0.77, P = 0.442) and margin of distal [(4.33 ± 1.90) vs (3.90 ± 2.02) cm, t = 1.54, P = 0.125] between the two groups; the postoperative complication rate of laparoscopy group and laparotomy group was 9.27% (9 cases ) and 7.92% (8 cases), respectively, the differencewas not statistically significance (χ2=0.01, P = 0.907); KPS score of laparoscopy group in 7 days after surgery were higher than laparotomy group [(79.33 ± 15.54) vs (73.49 ± 13.37), t = 2.84, P = 0.005], and in 30 days after surgery showed no statistical differences. Conclusion The clinical effect of 1aparoscopy-assisted distal gastrectomy for advanced gastric cancer is equivalent to the laparotomy, while with less trauma. Short-term quality of life in 1aparoscopy group is higher than laparotomy group.

Objective:To determine the plasma level of apelin in patients of maintenance hemodialysis (MHD) and to explore the relationship between apelin level and carotid atherosclerosis (AS) in MHD patients.Methods:A total of 92 MHD patients and 36 sex-and age-matched healthy subjects were enrolled in this study.The plasma level of apelin was evaluated by radiation immunoassay;serum endothelial injury markers including thrombomodulin,von Willebrand factor (vWF),and CD 146,and inflammatory factors including high sensitive C-reactive protein (hsCRP),IL-6 and TNF-α were determined by ELISA.Common Carotid arteries intima media thickness (CCA-IMT),cross-sectional calculated intima-media area (cIM area) area and atherosclerotic plaque were measured by non-invasive high-resolution B-mode ultrasonography.Results:The plasma levels of apelin was significantly decreased in MHD patients compared with healthy subjects (P＜0.01),accompanied with elevated plasma levels of thrombomodulin,vWF,CD 146,hsCRP,IL-6 and TNF-α (all P＜0.01).The plasma levels of apelinin in MHD patients with carotid artery plaques were obviously lower than those without plaques [(43.16± 10.12) pg/mL vs (61.43±16.25) pg/mL,P＜0.01].Plasma level of apelin was inversely related with CCA-IMT and cIM area (r=-0.355 and r=-0.297 respectively,all P＜0.01).Multiple stepwise regression analysis showed that plasma level of apelin was an independent risk factor for CCA-IMT and cIM area.Conclusion:The plasma apelin in MHD patients might take part in vascular endothelial injury and the progress of atherosclerosis.It plays an important role in the initiation and development of uremia associated atherosclerosis through elevating inflammatory factors including hsCRP,IL-6 and TNF-α levels.

Objective To evaluate prenatal sonograpic findings and clinical value in fetus with congenital portal-hepatic venous shunt.Methods The prenatal ultrasonographic characteristic of ten cases of congenital portal-hepatic venous shunt were analyzed and summarized.Results Three cases had portal vein-left hepatic venous shunt,two cases with portal vein-right hepatic venous shunt,two cases with situs inversus of left right portal vein,and three cases with multiple shunt among portal and hepatic veins.All the 10 cases with portal-hepatic venous shunt had common sonographic features,①Two-dimensional ultrasound revealed the distal hepatic veins.The hepatic vein and portal vein were both visualized on the same plane and connected by an anechoic area.②Vascular signal were noted inside the anechoic area.③Blood flow inside the anechoic area demonstrated by spectral Doppler was similar to that of the portal vein.Conclusions Prental ultrasonography is valuable in the diagnosis of fetal portal-hepatic venous shunt.

Objective:To evaluate the quality of prostate hyperplasia related literature in acupuncture and moxibustion,and to compare the curative effect on prostate hyperplasia between acupuncture and moxibustion and western medicine.Methods:Retrieving Pubmed,Cochrane Library,CBM database,CNKI database Etc.to collect the literature of prostate hyperplasia of clinical randomized or quasi-randomized control trials of comparative study between western medicine and acupuncture treatment.The data was extracted independently by two valuers from literatures fitting the selection criteria.Cochrane evaluation manual 4.2.6 was used to evaluate quality,and RevMan 4.2.8 was used in statistical analysis.Results:A total of six randomized or quasi-randomized controlled trials (total 546 examples) were adopted.6 study adopted the total effective rate of evaluation indexes,Meta-analysis showed that there was a significant difference between acupuncture treatment group and western medicine group [merger RR (fixed effects model)=1.26,95%CI(1.15,1.37),Z=5.13,P

Objective To observe the effect of Cordceps Sinensis (CS) on the expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in the kidney of spontaneously hypertensive rats(SHR), and to investigate the mechanism of CS. Methods Male SHRs (23 week old) were randomly divided into 4 groups: a group without any treatment (Group S), a group treated with Cordceps sinensis at 4 F), and a group received daily intragastric administration of CS at 4 male WKY rats were used as normals controls. At the end of 8 weeks, all rats were sacrificed. Serum creatinine(Scr), 24 h urinary protein count, and the expression of ICAM-1 and VCAM-1 were examined by immunohistochemical technique and RT-PCR. Results Compared with the WKY rats, blood pressure, 24 h urinary protein count, Scr,and the expression of ICAM-1 andVCAM-1 in the kidney of SHR significantly increased (P＜0.05).Compared with Group S, blood pressure decreased after treatment by fosinopril (P＜0.05). Compared with Group S, the levels of Scr, 24 h urinary protein count, and glomerular lesion were significantly reduced in the CS and/or fosinopril treatment group. The expression of ICAM-1 and VCAM-1 was significantly decreased in these groups (P＜0.05).Conclusion CS may play a role in the protection and anti-fibrosis in the process of renal injury in SHR through reducing the expression of ICAM-1 and VCAM-1.

Objective To investigate the experience of surgical treatment of primary extraperitoneal pelvic neoplasms,in order to improve tumor resection rate and safety.Methods The clinical data of 29 cases of primary extraperitoneal pelvic neoplasms were retrospectively analyzed from 1995 to 2013.To evaluate tumor resection preoperatively by CT,MRI and three dimensional reconstruction (3 d) medical technology,5 cases of preoperative interventional vascular embolization,intraoperative 2 cases in the iliac artery ligation,2 cases of intraoperative temporary blocking abdominal aorta.Intraoperative combined a variety of surgical approach to remove the tumor.Results Twenty-nine cases of patients,11 underwent tumor resection,5 underwent tumor resection and rectum resection plus sigmoid colostomy,the structure of 4 underwent tumor resection and repair damaged + sigmoid colon rectum temporary colostomy,3 underwent tumor resection and bladder partial nephrectomy,4 underwent tumor resection and uterine ovarian resection,2 underwent tumor resection + tail sacral tumor resection.25 patients recover well after the surgery,complications of 4 cases:intestinal obstruction in 2 cases respectively,pelvic abscess in 1 case,lower limb venous thrombosis in 1 case,cured by conservative and interventional therapy.No operative mortality and incidence of complications was 13.8％ (4/29).Conclusion Pelvic tumor preoperative imaging evaluation,combined incision and multi-visceral resection,fractional resection and recurrence after resection is the effective examination and treatment.

Objective: To evaluate the clinical value of color Doppler signal at the nasal lip in the diagnosis of fetal cleft palate. Methods: Twenty fetuses diagnosed with fetal cleft lip and cleft palate by targeted ultrasonography and magnetic resonance imaging were enrolled in this study. Color Doppler was used during each ultrasound scan. All prenatal diagnoses were confirmed either by postnatal follow-up or autopsy. The location and degree of cleft lip and palate was also recorded. During inspiration or swallowing color signal acrossed the defects at the fetal palate was indicated cleft palate, and no color signal acrossed the defects at the fetal palate was indicated without cleft palate. Two dimensional ultrasound combined with color Doppler was used to diagnose cleft lip and palate in midsagittal plane or paratsagittal plane, then compared with the results of post-natal evaluation or abortion, and the value of color signal at the nasal lip in the diagnosis of fetal cleft palate was analyzed. Results: Twenty cases of postpartum fetus (including post-natal evaluation or abortion ) confirmed 15 cases of cleft lip and palate, 5 cases of cleft lip (2 cases with upper alveolar cleft). For prenatal diagnosis, 5 cases of cleft lip and 15 cases of cleft lip and palate were diagnosed by two-dimensional ultrasound, of which 3 cases of cleft lip and palate were misdiagnosed as cleft lip, whereas 3 cases of cleft lip were misdiagnosed as cleft lip and palate with 2 cases combined with upper alveolar cleft. Two-dimensional ultrasound in the diagnosis of cleft lip and palate is consistent with postnatal results by additional evaluation of the color signal in nasolabial area in median sagittal section. In the cleft lip and cleft lip with the alveolar cleft fetuses, the color signal in nasolabial area was undetectable during fetal respiratory-like movement or swallowing by ultrasound.However, it was detectable in cleft lip and palate fetuses. A total of 3 cases of simple cleft lip and 17 cases of cleft lip and palate were detected by magnetic resonance imaging(MRI). In 2 cases of cleft lip and palate diagnosed by MRI, no blood flow signal was detected at the nasolabial area. Conclusions The connected color signal in nasolabial area assessed by color Doppler ultrasound during fetal respiratory-like movement or swallowing showed an promising value for prenatal diagnosis of cleft palate. Cleft palate could be ruled out if the connected color signal was undetectable in nasolabial area.

Objective: To explore the characteristics of gallstone-like echo in fetal gallbladder and its changes with gestational age, and following up its prognosis as well as the relationship with bilirubin after birth so as to provide more information for prenatal consultation about neonatal jaundice related diseases. Methods: A total of 82 fetuses from January 2014 to December 2017 at Women′s Hospital of Zhejiang University School of Medicine, who had prenatal ultrasound diagnosis and follow-up results with gallstone-like echo in fetal gallbladder, were included in this study. The characteristics of gallstone-like echo in fetal gallbladder were summarized, its change with gestational age, and its association with the status of pregnant mother were analyzed. Bilirubin and the prognosis of the gallstone-like echo were followed up after birth. Results: Four different types of prenatal ultrasound characteristics of gallstone-like echo in fetal gallbladder were observed: sediment-like type(n=13), full of hyperechoic type (n=19), multiple hyperechoic type (n=42), and single or scattered hyperechoic type(n=8). Of the total 82 cases, 2 fetus were induced abortion. In the 80 normal-born fetuses, the number of gallstone-like echo were reduced in 9 cases during pregnancy, the gallstone-like echo disappeared in uterus in 8 cases. During the follow up, the gallstone-like echoes disappeared at 3 days, 42 days, 1 year and 2 years after birth in the rest 72 cases, respectively. In the 80 fetuses, 20 cases of neonates with hyperbilirubinemia after birth (4 males and 16 females) including 4 cases of ABO hemolytic, 2 cases of neonatal sepsis.No abnormalities occurred in the remaining 60 neonates during the follow-up period. Conclusions Gallstone-like echo in fetus is a self-limiting disease that occurs in late pregnancy.Some neonates develop hyperbilirubinemia after birth with good prognosis. After phototherapy, the jaundice index decreased to the normal standard and the serum bilirubin content decreased.

Objective To evaluate the clinical value of color Doppler signal at the nasal lip in the diagnosis of fetal cleft palate . Methods Twenty fetuses diagnosed with fetal cleft lip and cleft palate by targeted ultrasonography and magnetic resonance imaging were enrolled in this study . Color Doppler was used during each ultrasound scan . All prenatal diagnoses were confirmed either by postnatal follow‐up or autopsy . T he location and degree of cleft lip and palate was also recorded . During inspiration or swallowing color signal acrossed the defects at the fetal palate was indicated cleft palate ,and no color signal acrossed the defects at the fetal palate was indicated without cleft palate . T wo dimensional ultrasound combined with color Doppler was used to diagnose cleft lip and palate in midsagittal plane or paratsagittal plane ,then compared with the results of post‐natal evaluation or abortion ,and the value of color signal at the nasal lip in the diagnosis of fetal cleft palate was analyzed . Results Twenty cases of postpartum fetus ( including post‐natal evaluation or abortion ) confirmed 15 cases of cleft lip and palate ,5 cases of cleft lip ( 2 cases with upper alveolar cleft) . For prenatal diagnosis ,5 cases of cleft lip and 15 cases of cleft lip and palate were diagnosed by two‐dimensional ultrasound ,of which 3 cases of cleft lip and palate were misdiagnosed as cleft lip ,w hereas 3 cases of cleft lip were misdiagnosed as cleft lip and palate with 2 cases combined with upper alveolar cleft . T wo‐dimensional ultrasound in the diagnosis of cleft lip and palate is consistent with postnatal results by additional evaluation of the color signal in nasolabial area in median sagittal section . In the cleft lip and cleft lip with the alveolar cleft fetuses ,the color signal in nasolabial area was undetectable during fetal respiratory‐like movement or swallowing by ultrasound .However ,it was detectable in cleft lip and palate fetuses . A total of 3 cases of simple cleft lip and 17 cases of cleft lip and palate were detected by magnetic resonance imaging( M RI) . In 2 cases of cleft lip and palate diagnosed by M RI ,no blood flow signal was detected at the nasolabial area . Conclusions The connected color signal in nasolabial area assessed by color Doppler ultrasound during fetal respiratory‐like movement or swallowing showed an promising value for prenatal diagnosis of cleft palate . Cleft palate could be ruled out if the connected color signal was undetectable in nasolabial area .