Objective To explore the therapeutic efficacy of modified Taohong Siwu Decoctio n(TSD) combined with limited internal fixation and external fixation for the treatment of tibial plateau fracture of Schatzker type Ⅴand Ⅵ. M ethods A total of 31 cases of tibial plateau fractures of Schatzker type Ⅴ and Ⅵ treated with TSD orally combined with limited internal fixation and external fixation were enrolled into the study. Follow-up was carried out for the evaluation of therapeutic effect and postoperative complications. Results All of the cases received follow-up for 6 months to 3 years. According to Merchant scoring criteria, the therapeutic effect was excellent for 15 cases, good for 12 cases, acceptable for 3 cases and inferior for one case, with the excellent and good rate being 87.1%. One case had pin tract infection, and then was cured after symptomatic treatment. Conclusion For tibial plateau fracture of Schatzker typeⅤandⅥwith unsatisfactory skin state, we can perform limited internal fixation and external fixation to take the place of strong steel plate fixation with extensive exposure for surgical treatment, and then give postoperative oral use of TSD, which will be a safe and effective therapy for the fracture by promoting the relief of the clinical symptoms and signs of early fracture.

Objective To observe the influence of early intestinal barrier protection in patients with severe acute pancreatitis(SAP). Methods To analyze the therapeutic methods and prognosis of 56 patients with SAP. The patients were randomly divided into the conventional therapy group (A) and the intestinal barrier protection group (B). The APACHE Ⅱ score, Ranson score, Marshall score, CT severity index (CTSI), gastrointestinal functions score (GFS), the ratio of Lactulose to Mannitol (L/M), plasma Endotoxin and Diamine Oxidase (DAO), serum C-reactive protein (CRP) and TNF-α, incidence of pancreatic infection and multiorgan dysfunction syndrome (MODS), and the hospitalization mortality were compared between the two groups. Results On the 7th day after admission, the APACHE Ⅱ score, GFS, L/M, Endotoxin, DAO, CRP and TNF-α were significantly less in group B than in group A (P<0. 05). There was no significant difference in the CTSI (P>0. 05)between the two groups at 2nd week after admission. The incidence of pancreatic infection and MODS in group B were significantly lower than in group A (P<0. 05). The hospitalization mortality was not significantly different (P>0. 05) between the two groups. Conclusion Early intestinal barrier protection in SAP alleviated systemic inflammatory response, and reduced the incidences of pancreatic infection and MODS, thus improved the prognosis.

Cerebral arteriovenous malformation (AVM) is a common cerebrovascular disease in clinical practice. Although the treatment of AVMs has been w idely studied, the prognosis of the patients does not get significantly improvement. The main therapeutic purpose of AVMs is to reduce the risk of bleeding. This article review s the risk of bleeding and treatment modalities of AVMs.

Objective To assess the feasibility and short-term effect of transanal everted extraction of laparoscopic rectal excision without abdominal incision.Methods Eleven patients were operated by transanal everted extraction of laparoscopic rectal excision without abdominal incision.Results All the operations were accomplished successfully,the average operative duration was (189.5±25.2) min,the intra-operative blood loss volume was (25.4±9.4) ml,the average time to flatus was (38.9±8.6) h,the average postoperative hospital stay was (12.7±2.5) d,and the number of lymph nodes harvested was 13.5±4.1.There were no post-operative complications.Conclusion The technique of transanal everted extraction of laparoscopic rectal excision without abdominal incision is safe and feasible,but the long-term effects need more observation.

Objective To compare the clinical effects of three-dimensional (3D) and two-dimensional (2D) laparoscopic surgeries for rectal cancer (RC) after neoadjuvant chemoradiation therapy (nCRT).Methods The retrospective cohort study was conducted.The clinicopathological data of 126 patients with RC who received laparoscopic surgery after nCRT in the Liaoning Cancer Hospital from January 2013 to January 2014 were collected.Of 126 patients,63 undergoing 3D laparoscopic surgery and 63 undergoing 2D laparoscopic surgery were respectively allocated into the 3D and 2D groups.Surgery was performed by the same doctors' team.Patients received surgery at 6-8 weeks after nCRT,and surgery followed the principle of total mesorectal excision.Observation indicators:(1) intra-and post-operative situations;(2) postoperative pathological examination;(3)follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect local tumor recurrence and patients' survival up to January 2017.Patients received reexaminations once every 3 months within 1 year postoperatively and once every 6 months after 2-3 years postoperatively.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Comparisons of count data were analyzed using the chi-square test.Comparison of ordinal data was done by the nonparametric test.Survival curve was drawn using the Kaplan-Meier method.Survival was analyzed using the Logrank test.Results (1) Intra-and post-operative situations:all the patients underwent successful laparoscopic surgery for RC,without conversion to open surgery and perioperative death.Operation time,volume of intraoperative blood loss,time to anal exsufflation and number of patients with postoperative urinary dysfunction were (125±10)minutes,(54±23)mL,(44±5)hours,0 in the 3D group and (137±12)minutes,(62±20)mL,(46±5) hours,5 in the 2D group,respectively,with statistically significant differences between the 2 groups (t=5.777,2.038,2.575,x2 =7.138,P＜0.05).Number of patients with preserving anus,number of lymph node dissected,number of patients with anastomotic fistula and duration of hospital stay were 60,14.9±2.1,2,(9.5±0.8)days in the 3D group and 58,14.3± 1.7,4,(9.9±2.0)days in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2 =0.133,t=1.606,x2 =0.175,t =1.329,P＞0.05).Two and 4 patients with anastomotic leakage in the 3D and 2D groups received defunctioning stoma,and finally anastomotic leakage healed,without anastomotic stenosis.Of 5 patients with urinary dysfunction in the 2D group,4 received indwelling catheter for 3 weeks and then can micturate autonomously after indwelling catheter removal,1 received indwelling catheter for 3 months and then can micturate autonomously after indwelling catheter removal,without suprapubic cystostomy.(2) Postoperative pathological examination:0 and 4 patients in the 3D and 2D groups had positive circumferential margin,with a statistically significant difference (x2=5.676,P＜0.05).One and 2 patients in the 3D and 2D groups had positive distal margin,with no statistically significant difference (x2 =1.606,P＞0.05).Number of patients with stage Ⅱ and Ⅲ of postoperative pathological staging were 30,33 in the 3D group and 32,31 in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2=0.127,P＞0.05).(3) Follow-up and survival situations:126 patients were followed up for 36.0-48.0months,with a median time of 39.5 months.During the follow-up,0 and 3 patients in the 3D and 2D groups were complicated with local tumor recurrence,with a statistically significant difference between the 2 groups (x2 =4.232,P＜0.05).One-and 3-year overall survival rates were 98.4％,82.5％ in the 3D group and 96.8％,79.4％ in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2 =0.206,P＞0.05).One-and 3-year disease-free survival rates were 92.7％,77.8％ in the 3D group and 90.5％,73.0％in the 2D group,respectively,with no statistically significant difference between the 2 groups (x2=0.421,P＞0.05).Conclusion Compared with 2D laparoscopic surgery,3D laparoscopic surgery for RC after nCRT is safe and feasible,it can also shorten operation time,reduce intraoperative bleeding,alleviate the influence of intestinal peristalsis function,protect pelvic nerves better and improve operation quality.

Objective To investigate the clinical effects and advantages of flexible 3D laparoscopic surgery on rectal cancer after neoadjuvant chemoradiotherapy (nCRT). Methods The data of 152 patients who received laparoscopic rectal cancer resection after nCRT excluding the cases of high rectal cancer, cardiac and pulmonary dysfunction were analyzed from January 2015 to January 2016 in the Department of Colorectal Surgery of Liaoning Cancer Hospital. The distances from the annal edge to the inferior tumor margin were within 8 cm in these patients. Among these patients, 76 cases received the 3D laparoscopic surgery after nCRT (3D-nCRT), and 76 cases undergone the 2D laparoscopic surgery after nCRT (2D-nCRT). Results Between two groups, the number of lymph node harvest (14.8±2.1 vs. 14.3±1.7), positive rate of the distal margin [1.3 % (1/76) vs. 2.6 % (2/76)], reserving anus rate [92.1 % (70/76) vs. 81.2 % (67/76)], local recurrence rate [1.3 % (1/76) vs. 3.9 % (3/76)] and anastomotic leakage rate [2.6 % (2/76) vs. 3.9 % (3/76)] had no statistical differences (all P>0.05), while the operative time [(125.3±10.2) min vs. (136.6±12.0) min], intraoperative bleeding [(54.1±23.2) ml vs. (61.9±19.5) ml], anus exhaust time [(43.5±5.0) h vs. (45.4±5.6) h] and positive rate of circumferential resection margin (CRM) [1.3 % (1/76) vs. 9.2 % (7/76)] had statistical differences (all P< 0.05). Conclusion Flexible 3D laparoscopic surgery on rectal cancer after nCRT can shorten operative time, reduce intraoperative bleeding, alleviate the influence of intestinal peristalsis function, and improve operative quality.

Objective:To nvestigate the clinical curative effects and advantages on neoadjuvant chemoradiation therapy (nCRT) combined with laparoscopy in lower rectal reserving annus surgery.Methods:we make a retrospective analysis of 141 patients (nCRT group) who received nCRT combined with laparoscopic rectal cancer resection and of 141 cases simply received laparoscopic rectal cancer resection at the same period in the department of coiorectal surgery,Cancer Hospital of China Medical University、Liaoning Cancer Hospital&Institute,from December 2013 to December 2015.Results:Two groups in operation time,anus exhausting time,hospital stay time,number of harvest lymph node,incision infection rate,anastomotic leakage rate are not statistic differences;Two groups of reserving anus rate (136/141 vs 125/141,P＜0.05),intraoperating bleeding (54.8 ± 23.4ml vs 69.7 ± 29.1 mL,P＜0.05),positive rate of distance resection margin (0/141VS 2/141,P＜0.05),length of distance resection margin(2.35 ± 0.70VS2.02 ± 0.46,P＜0.05),local recurrence rate (2/141 VS 9/141,P＜0.05) are statistic differences.Conclusion:Neoadjuvant chemoradiation therapy(nCRT) combined with laparoscopic rectal resection can improve reserving anus rate and reduce local recurrence rate.

INTRODUCTION: Sepsis is defined as a life-threatening complication that occurs when the body responds to an infection attacking the host. Sepsis rapidly progresses and patients deteriorate and develop septic shock, with multiple organ failure, if not promptly treated. Currently no effective therapy is available for sepsis; therefore, early diagnosis is crucial to decrease the high mortality rate. Genome-wide expression analyses of patients in critical conditions have confirmed that the expression levels of the majority of genes are changed, suggesting that the molecular basis of sepsis is at the gene level. This review aims to elucidate the role of circular (circ) RNAs in the pathogenesis of sepsis and sepsis-induced organ damage. In addition, the feasibility of using circRNAs as novel diagnostic biomarkers for sepsis is also discussed, as well as circRNA-based therapy. METHOD: This narrative review is based on a literature search using Medline database. Search terms used were "circular RNAs and sepsis", "circRNAs and sepsis", "non-coding RNAs and sepsis", "ncRNAs and sepsis", "circRNAs and septic pathogenesis", "circRNAs and septic model", "circRNAs and septic shock" and "circRNAs, biomarker, and sepsis". RESULTS: Numerous studies indicate that circRNAs might exert pivotal roles in regulating the immune system of the host against various pathogens, such as bacteria and viruses. Dysregulation of circRNA expression levels has been confirmed as an early event in sepsis and associated with the inflammatory response, immunosuppression and coagulation dysfunction. This impairment in regulation eventually leads to multiple organ dysfunctions, including of the kidneys, lungs and heart. CONCLUSION By investigating the regulation of circRNAs in sepsis, new molecular targets for the diagnosis and intervention of sepsis can be identified. Such an understanding will be important for the development of therapeutic drugs.
Biomarkers ; Humans ; RNA, Circular ; Shock, Septic/genetics*

Objective:To investigate the clinical value of continuous increase of blood lactic acid (Lac) in prognosis evaluation of patients with sepsis.Methods:From January 2016 to December 2018, 84 patients with sepsis in the Department of Critical Medicine of Lanzhou First People's Hospital were retrospectively analyzed. According to the final outcome, the patients were divided into death group and survival group. The general condition, initial Lac, Lac at 6, 12, 18, 24 h, and the duration of Lac>2 mmol/L (T Lac>2) were compared between the two groups. Receiver operating characteristic curve (ROC) was used to analyze the sensitivity and specificity of gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), initial lac, 6, 12, 18, 24 h lac, T Lac>2 in evaluating the prognosis of patients with sepsis. At the same time, the relationship between these parameters and the prognosis of patients was analyzed by Cox regression analysis to evaluate the clinical value of the time of continuous increase of blood lactate in the prognosis of patients with sepsis. Results:There was no significant difference in age, gender, APACHE Ⅱ score and initial lac between the two groups ( P>0.05). The Lac of death group was higher than that of survival group at 6, 12, 18 and 24 h after treatment ( P<0.05), and T Lac>2 in death group was significantly longer than that in survival group ( P<0.05). Cox regression analysis showed that age, gender, APACHE Ⅱ score, initial Lac, 6, 12, 18, 24 h lac had no significant effect on the prognosis of sepsis patients, while T Lac>2 was significantly correlated with survival rate and death risk. The longer T Lac>2 was, the lower the survival rate and the higher the risk of death. At the same time, ROC curve analysis showed that gender, age, APACHE Ⅱ score and area under the curve (AUC) of initial lac showed that these indicators could not effectively evaluate the prognosis of patients ( P>0.05). The area under the curve of T Lac>2 was the largest, and the evaluation of prognosis was the best, followed by 24 h Lac and 18 h, 12 h and 6 h Lac. In addition, the sensitivity of T Lac>2, 24, 18, 12, 6 h for sepsis mortality risk assessment were 90.9%, 81.8%, 81.8%, 81.8%, 88.6%, and the specificity were 71.4%, 52.5%, 52.5%, 47.7% and 25.2%, respectively. Conclusions:Transient increase of lactic acid can not evaluate the prognosis of patients with sepsis, but the duration of lactic acid increase has a significant impact on the prognosis of patients with sepsis. The longer the increase of Lactic acid (T Lac>2) is, the lower the survival rate and the higher the risk of death. The sensitivity and specificity of lactic acid duration in evaluating the risk of death were higher than those of other parameters, and the prognostic efficacy was the best.

In this study we synthesized a micro- and mesoporous material, SBA-16. And later on we functionalized it with octyltrimethoxysilane and octadecyltrimethoxysilane, respectively. The materials of SBA-16 and its functionalized form were characterized by nitrogen adsorption isotherms at 77K, small angle X-ray scattering (SAXS), Fourier-transform infrared (FT-IR), thermal gravimetric analysis (TGA), and adsorption isotherms of single component n-heptane, toluene and water vapour. The data of FT-IR and TGA demonstrated the successful chemical modification of surface and porous wall of SBA-16 with different hydrocarbon chains. The results of SAXS, nitrogen adsorption at 77K, and adsorption isotherms of probe molecules revealed that the functionalized SBA-16 materials possessed relatively less regularity, smaller BET surface area and pore volumes, and lower adsorption capacities for the probe molecules compared to the original SBA-16. However, the functionalized SBA-16 materials showed much less affinity to polar molecules such as water. This work provides useful fundamental information for future study of novel mesoporous silica materials as potential drug delivery carriers.
Adsorption ; Drug Carriers ; chemistry ; Porosity ; Silicon Dioxide ; chemistry ; Surface Properties