Objective To determine the content of aconitine-type alkaloids in Bitongxiao Ointment,and to control the limits of aconitine-type alkaloids in the ointment.Methods Acid-dye colorimetry was employed and methodology was examined for linear range,average recovery,precision,exclusivity and stability.Results The method has a good precision and stability.The linear range of aconitine-type alkaloids was in 0.111 9～0.714 mg(r=0.999 3),and the average recovery was 97.4 %.Conclusion The method is accurate,reliable,simple,can be used to determine the content of aconitine-type alkaloids in Bitongxiao Ointment.

Objective To evaluate the effects of different interventios on insulin resistance and ?-cell function in population with impaired glucose tolerance(impaired glucose tolerance,IGT).Methods The total of 382 cases of IGT were divided into five groups according to interventions:control(C),diet plus exercise group(D+E),Acarbose Group(A),Metformin(M)and traditional Chinese medicine Group(TCM),with each group making the appropriate intervention programmes.BMI,FPG,2hPG,F-Ins,P-Ins,F-CP and P-CP were determined before intervention and yearly during the follow up,and BMI,HOMA-IR,HOMA-? were calculated.Results By the end of the study,insulin,F-CP,IR Group D+E and FPG,2hPG,insulin,C-peptide,IR in the other groups were significantly lower than before the intervention(P

Objective:To assess the efficacy of butylphthalide and sodium chloride injection combined with interventional therapy in treatment of patients with acute anterior circulation macrovascular occlusive stroke.Methods:Clinical data of 92 patients with acute anterior circulation macrovascular occlusive stroke admitted to the Department of Neurology of Luoyang Central Hospital Affiliated to Zhengzhou University from February 2018 to June 2019 were retrospectively analyzed. Among them, 46 cases were treated with auxiliary arterial thrombolysis, aspiration thrombectomy or balloon dilatation (control group); and 46 patients were treated with butylphthalide and sodium chloride injection combined with Solitaire AB (S-AB) recyclable stent (study group). In control group the lesions were located in distal end internal carotid artery ( n=4), M1 segment of middle cerebral artery ( n=18) and M2 segment of middle cerebral artery ( n=24). In study group the lesions were located in the distal end of internal carotid artery ( n=5), M1 segment of middle cerebral artery ( n=15) and M2 segment of middle cerebral artery ( n=26). The cerebral infarction thrombolysis classification was used to evaluate vascular recanalization during operation. The neurological function of the patients before and 4 weeks after operation was evaluated with National Institutes of Health Stroke Scale Score (NIHSS); and the Disease Disability Scale Score (MRS) was also used to evaluate the neurological function before and 2 and 4 weeks after operation. Results:There was no significant difference in NIHSS score before treatment between control group and study group (22.8±5.2 vs. 23.4±4.1, t=0.614, P=0.54); after treatment the NIHSS of study group was significantly lower than that of control group (7.6±1.1 vs. 12.2±1.6, t=16.068, P<0.01). The success rate of vascular recanalization in the study group was higher than that of the control group [91%(42/46) vs. 76%(35/46), χ 2=3.903, P=0.04]. The short-term recanalization rate was 84% (39/46) and occlusion rate was 15%(7/46) in study group, while those in control group were 70% (32/46) and 30% (14/46), respectively (χ 2=6.566, P=0.01; χ 2=6.566, P=0.01) . MRS scores at 2 and 4 weeks after operation in the study group (5.51±0.34, 2.39±0.47) were better than those in the control group (6.87±0.46, 3.26±0.39; t=16.125, 9.661, all P<0.01) . Conclusion:Butylphthalide and sodium chloride injection combined with S-AB recyclable stent can enhance the nerve function and improve the hemagglutination mechanism in patients with acute anterior circulation macrovascular occlusive stroke and also significantly improve the vascular recanalization rate.

Objective To investigate the effect of 0.45 ％ saline for airway humidification in patients with craniocerebral injury after tracheotomy.Methods A total of 58 patients with craniocerebral injury after tracheotomy treated in our department were as observation group,given 0.45％ saline for airway humidification.And 40 craniocerebral injury patients after tracheotomy at the same time were as control group,given sterilized saline for airway humidification.The effect of airway humidification,the rate of sputum scab formation,and the incidence of adverse reactions were compared between the two groups.Results The pH of sputum after 3,5 d of tracheotomy in the observation group was lower (P ＜ 0.05),but the effect of airway humidification and the rate of sputum scab formation in the two groups showed no statistically significant difference (P ＞ 0.05).The incidence of pulmonary infection,irritating cough and respiratory mucosal bleeding in the observation group were lower than that in the control group (P ＜ 0.05).Conclusion The 0.45％ saline solution for airway humidification is in accordance with the physiological needs of the patients,and has better wetting effect and lower incidence of adverse events.

Objective To investigate the effect of 0.45 ％ saline for airway humidification in patients with craniocerebral injury after tracheotomy.Methods A total of 58 patients with craniocerebral injury after tracheotomy treated in our department were as observation group,given 0.45％ saline for airway humidification.And 40 craniocerebral injury patients after tracheotomy at the same time were as control group,given sterilized saline for airway humidification.The effect of airway humidification,the rate of sputum scab formation,and the incidence of adverse reactions were compared between the two groups.Results The pH of sputum after 3,5 d of tracheotomy in the observation group was lower (P ＜ 0.05),but the effect of airway humidification and the rate of sputum scab formation in the two groups showed no statistically significant difference (P ＞ 0.05).The incidence of pulmonary infection,irritating cough and respiratory mucosal bleeding in the observation group were lower than that in the control group (P ＜ 0.05).Conclusion The 0.45％ saline solution for airway humidification is in accordance with the physiological needs of the patients,and has better wetting effect and lower incidence of adverse events.

Objective:To investigate the learning curve for a five-step procedure, namely, a transthoracic single-port assisted laparoscopic transabdominal diaphragmatic approach, for Siewert type II adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, we analyzed relevant clinical data of 66 patients with Siewert type II adenocarcinoma of the esophagogastric junction who had undergone the five-step procedure performed by the same surgeon in the Gastrointestinal Surgery Department of Guangdong Provincial Hospital of Chinese Medicine from May 2017 to April 2023. The learning curve were plotted using cumulative summation analysis and selected indicators, including intraoperative blood loss, duration of surgery, time to first flatus, time to first tolerance of liquid food, length of hospital stay, and incidence of perioperative complications at different stages were compared. The data were analyzed using SPSS 24.0 statistical software. Numerical data are presented as cases (%) and data were analyzed using the χ 2 test or Fisher's exact test. Normally distributed measurement data are presented as x±s, and independent sample t-testing was performed for inter group comparison. Non-normally distributed measurement data are presented as M( Q1, Q3) and the Mann–Whitney U test was used for inter group comparison. Results:The five-step procedure had been successfully completed without switching to open surgery in all 66 study patients. There were no perioperative deaths, blood loss was 100 (50, 200) mL and duration of surgery 329.4±87.3 minutes. The equation of optimal fit for the duration of surgery was y=0.031x 3-4.4757x 2+164.97x-264.4 ( P<0.001, R2=0.9797). The cumulative summation learning curve reached a vertex when 25 surgical procedures had accumulated. Using 25 cases as the cut-off, we divided the learning curves into learning and proficiency periods and patients into learning (25) and proficiency period groups (41). There were no statistically significant differences between the two groups of patients in sex, age, body mass index, American Society of Anesthesiologists score, history of abdominal surgery, comorbidities, preoperative neoadjuvant therapy, maximum tumor diameter, surgical procedure, or T and N stage of tumor ( P>0.05). The following factors differed significantly (all P<0.05) between the learning and proficiency stages: in the latter there was less intraoperative blood loss (100 [50, 100] ml vs. 200 [100, 200] ml, U=-3.940, P<0.001), shorter duration of surgery ([289.8±50.7] minutes vs. [394.4±96.0] minutes, t=5.034, P<0.001), more mediastinal lymph nodes removed (5 [2, 8] vs. 2 [1, 5], U=-2.518, P=0.012), earlier time to first flatus (2 [2, 3] days vs. 4 [3, 6] days, U=-4.016, P<0.001), earlier time to first tolerance of liquid food (5 [4, 6] days vs. 7 [6, 8] days, U=-2.922, P=0.003), shorter duration of hospital stay (8 [8, 10] vs. 10 [9, 12] days, U=-2.028, P=0.043). The incidence of surgical complications did not differ significantly between the two groups ( P=0.238). Conclusion:Satisfactory results can be achieved with the five-step procedure for patients with Siewert type II adenocarcinoma of the esophagogastric junction once 25 procedures have been performed.

Objective:To explore the application of anterior esophageal wall full layer fixation and gastric tube guidance in total laparoscopic overlap method for intracorporeal esophagojejunostomy.Methods:Overlap esophagojejunostomy with anterior esophageal wall full layer fixation and gastric tube guidance is suitable for patients with advanced gastric cancer (clinical stage: cT1b~4aN0~3M0) and esophageal invasion <3 cm, who underwent radical total gastrectomy+ overlap esophagojejunostomy. The main operation procedure was performed as follows: A titanium clip was used for fixation of the full anterior wall of esophagus before overlap esophagojejunostomy, and the side‐to‐side esophagojejunostomy was performed with the linear stapler under the guidance of gastric tube. Then the titanium clip was removed after confirming that the correct cavity was entered. Finally, the common outlet was closed by two barbed sutures. A descriptive case series study was conducted. The clinical data of patients who underwent laparoscopic radical gastrectomy and overlap esophagojejunostomy with anterior esophageal wall full layer fixation and gastric tube guidance in Guangdong Provincial Hospital of Chinese medicine and the First Affiliated Hospital of Guangzhou University of Chinese medicine from May 2021 to June 2023 were retrospectively analyzed.Results:A total of 42 patients were collected, and all of them were successfully completed laparoscopic total radical gastrectomy without conversion to laparotomy or perioperative death. The esophagojejunostomy time, operative time, intraoperative blood loss was 17(5‐25) minutes, (258.8±38.0) minutes and 50(20‐200) ml, respectively. The incidence of esophageal false lumen was 0%, and there were no intraoperative complications. The time of gastric tube removal, initial fluid diet intake and the duration of postoperative hospital were 2(1‐5) , 4(1‐8) and 8(4‐21) days, respectively. There were no postoperative anastomotic hemorrhage, anastomotic stenosis and other related complications. One patient (2.38%) developed a Clavien‐Dindo IIIb complication, which was abdominal hemorrhage after operation. The second surgical exploration confirmed that the patient was bleeding due to gastroduodenal artery rupture. After intraoperative suture hemostasis, fluid expansion, blood transfusion and other treatments, the patient was discharged on the 15th day after the operation. Three patients (7.14%) developed Clavien‐Dindo grade II complications, including anastomotic leakage, chylous leakage and pulmonary infection, and were discharged after conservative treatment such as anti‐infection and prolonged retention of drainage tube.Conclusions:Laparoscopic overlap method for intracorporeal esophagojejunostomy with anterior esophageal wall fixation and gastric tube guidance can shorten the time of esophagojejunostomy and prevent the occurrence of false lumen, and do not increase anastomose‐related complications.

Objective:To investigate the learning curve for a five-step procedure, namely, a transthoracic single-port assisted laparoscopic transabdominal diaphragmatic approach, for Siewert type II adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, we analyzed relevant clinical data of 66 patients with Siewert type II adenocarcinoma of the esophagogastric junction who had undergone the five-step procedure performed by the same surgeon in the Gastrointestinal Surgery Department of Guangdong Provincial Hospital of Chinese Medicine from May 2017 to April 2023. The learning curve were plotted using cumulative summation analysis and selected indicators, including intraoperative blood loss, duration of surgery, time to first flatus, time to first tolerance of liquid food, length of hospital stay, and incidence of perioperative complications at different stages were compared. The data were analyzed using SPSS 24.0 statistical software. Numerical data are presented as cases (%) and data were analyzed using the χ 2 test or Fisher's exact test. Normally distributed measurement data are presented as x±s, and independent sample t-testing was performed for inter group comparison. Non-normally distributed measurement data are presented as M( Q1, Q3) and the Mann–Whitney U test was used for inter group comparison. Results:The five-step procedure had been successfully completed without switching to open surgery in all 66 study patients. There were no perioperative deaths, blood loss was 100 (50, 200) mL and duration of surgery 329.4±87.3 minutes. The equation of optimal fit for the duration of surgery was y=0.031x 3-4.4757x 2+164.97x-264.4 ( P<0.001, R2=0.9797). The cumulative summation learning curve reached a vertex when 25 surgical procedures had accumulated. Using 25 cases as the cut-off, we divided the learning curves into learning and proficiency periods and patients into learning (25) and proficiency period groups (41). There were no statistically significant differences between the two groups of patients in sex, age, body mass index, American Society of Anesthesiologists score, history of abdominal surgery, comorbidities, preoperative neoadjuvant therapy, maximum tumor diameter, surgical procedure, or T and N stage of tumor ( P>0.05). The following factors differed significantly (all P<0.05) between the learning and proficiency stages: in the latter there was less intraoperative blood loss (100 [50, 100] ml vs. 200 [100, 200] ml, U=-3.940, P<0.001), shorter duration of surgery ([289.8±50.7] minutes vs. [394.4±96.0] minutes, t=5.034, P<0.001), more mediastinal lymph nodes removed (5 [2, 8] vs. 2 [1, 5], U=-2.518, P=0.012), earlier time to first flatus (2 [2, 3] days vs. 4 [3, 6] days, U=-4.016, P<0.001), earlier time to first tolerance of liquid food (5 [4, 6] days vs. 7 [6, 8] days, U=-2.922, P=0.003), shorter duration of hospital stay (8 [8, 10] vs. 10 [9, 12] days, U=-2.028, P=0.043). The incidence of surgical complications did not differ significantly between the two groups ( P=0.238). Conclusion:Satisfactory results can be achieved with the five-step procedure for patients with Siewert type II adenocarcinoma of the esophagogastric junction once 25 procedures have been performed.

Objective:To explore the application of anterior esophageal wall full layer fixation and gastric tube guidance in total laparoscopic overlap method for intracorporeal esophagojejunostomy.Methods:Overlap esophagojejunostomy with anterior esophageal wall full layer fixation and gastric tube guidance is suitable for patients with advanced gastric cancer (clinical stage: cT1b~4aN0~3M0) and esophageal invasion <3 cm, who underwent radical total gastrectomy+ overlap esophagojejunostomy. The main operation procedure was performed as follows: A titanium clip was used for fixation of the full anterior wall of esophagus before overlap esophagojejunostomy, and the side‐to‐side esophagojejunostomy was performed with the linear stapler under the guidance of gastric tube. Then the titanium clip was removed after confirming that the correct cavity was entered. Finally, the common outlet was closed by two barbed sutures. A descriptive case series study was conducted. The clinical data of patients who underwent laparoscopic radical gastrectomy and overlap esophagojejunostomy with anterior esophageal wall full layer fixation and gastric tube guidance in Guangdong Provincial Hospital of Chinese medicine and the First Affiliated Hospital of Guangzhou University of Chinese medicine from May 2021 to June 2023 were retrospectively analyzed.Results:A total of 42 patients were collected, and all of them were successfully completed laparoscopic total radical gastrectomy without conversion to laparotomy or perioperative death. The esophagojejunostomy time, operative time, intraoperative blood loss was 17(5‐25) minutes, (258.8±38.0) minutes and 50(20‐200) ml, respectively. The incidence of esophageal false lumen was 0%, and there were no intraoperative complications. The time of gastric tube removal, initial fluid diet intake and the duration of postoperative hospital were 2(1‐5) , 4(1‐8) and 8(4‐21) days, respectively. There were no postoperative anastomotic hemorrhage, anastomotic stenosis and other related complications. One patient (2.38%) developed a Clavien‐Dindo IIIb complication, which was abdominal hemorrhage after operation. The second surgical exploration confirmed that the patient was bleeding due to gastroduodenal artery rupture. After intraoperative suture hemostasis, fluid expansion, blood transfusion and other treatments, the patient was discharged on the 15th day after the operation. Three patients (7.14%) developed Clavien‐Dindo grade II complications, including anastomotic leakage, chylous leakage and pulmonary infection, and were discharged after conservative treatment such as anti‐infection and prolonged retention of drainage tube.Conclusions:Laparoscopic overlap method for intracorporeal esophagojejunostomy with anterior esophageal wall fixation and gastric tube guidance can shorten the time of esophagojejunostomy and prevent the occurrence of false lumen, and do not increase anastomose‐related complications.