Hepatocellular carcinoma (HCC) has an insidious onset and when a confirmed diagnosis is made,most patients lose the chance for surgery and are given transarterial chemoembolization (TACE) as palliative treatment.However,repeated TACE may lead to overexpression of hypoxia-inducible factor 1 α (HIF-1 α) and vascular endothelial growth factor (VEGF),liver injury,and reduced immune function and has poor long-term efficacy.The introduction of Huai'er granules may help to change the current status.Studies in China and foreign countries have shown that Huai'er granules exert a remarkable anti-tumor effect by blocking cell cycle,inducing cell apoptosis,inhibiting cell proliferation and invasion,and blocking the hepatitis B-hepatocellular carcinoma pathway.Meanwhile,as an adjuvant drug for HCC,Huai'er granules cover the shortcomings of TACE from multiple aspects and can effectively inhibit the overexpression of HIF-1o and VEGF,improve liver injury and immunity,enhance the effect of chemotherapy drugs,and reverse drug resistance.Many clinical studies have confirmed the remarkable advantages of Huai'er granules combined with TACE,and their synergistic effect helps to enhance anti-tumor effect and improve short-and long-term survival rates.

Parkinson's disease(PD)is the most common neurodegenerative disease in middle-aged and elderly people.Constipation is one of the most common non-motor symptoms of PD.Anorectal manometry can objectively reflect anorectal movement and sensory function,and is one of the necessary tests to check anorectal function,judge the type of constipation,and evaluate the effect of constipation treatment.This paper expounds the detection indicators and significance of anorectal manometry,and summarizes the characteristics of anorectal manometry in PD patients with constipation:decreased maximum anal systolic pressure,insufficient rectal propulsion,decreased rectal sensitivity,and the type of constipation in PD patients is mainly outlet obstruction with contradictory anal contraction or insufficient relaxation during defecation.

Objective:To analyze the effective and safety of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (RAAA) at one tertiary center, and to improve the outcomes of RAAA under fast-track protocol.Methods:Nineteen cases of RAAA in the 940th Hospital of Joint Logistic Support Force of PLA from January 2014 to December 2020 were reviewed retrospectively. EVAR-fist strategy was employed from the emergency room to the operating room by using fast-track protocol. Preoperative management, anatomic characteristics, choice of anesthesia, operative procedures and postoperative complications were collected and analyzed. Abdominal compartment syndrome (ACS) and hospital mortality were paid special attention.Results:Nineteen cases were undergone EVAR procedures. The age was (73.4 ± 7.4) years old, and the AAA size was (67.8 ± 13.6) mm. Two cases underwent cardiopulmonary resuscitation at emergency department. General anesthesia was used in 13 patients and local anaesthesia in 6 patients. Successful stent graft deployment was achieved in all cases. The duration from emergency room to operating room was (84.8 ± 22.4) min. The hospital stay time was (9.7 ± 5.7) d. The hospital mortality was 5/19. The 5 deaths were reviewed: 3 died for multiple organ failure, 1 for irreversible shock, and 1 for ongoing bleeding.Conclusions:Excellent results were confirmed by using EVAR-first strategy for RAAA. The management of hemodynamically unstable state, standardized endovascular procedure, fast-track program and multidiscipline team collaboration were the very important determining factors for the implementation of EVAR. Focused efforts to reduce RAAA mortality are warranted.

Objective: To investigate the clinical value of preoperative selective arterial embolization for spinal tumors. Methods: The clinical data of 42 consecutive patients who underwent spinal tumor resection in department of orthopedics Shengjing Hospital of China Medical University from January 2017 to December 2018 were retrospectively analyzed. Patients were divided into embolization group (20 cases) and non-embolization group (22 cases) according to whether they underwent arterial embolization before tumor resection. Two surgical treatments including vertebral resection and laminectomy were performed. The embolization group included 12 cases of vertebral resection and 8 cases of laminectomy; while the non-embolization group included 13 cases of vertebral resection and 9 cases of laminectomy. The difference of intraoperative estimated blood loss, total number of transfused packed red blood cell, calibrated estimated blood loss, operation time and hospitalization time were compared using independent sample t test. Results: Twenty patients in the embolization group underwent successful interventional embolization without serious complications. There were no significant differences between the embolization group and the non-embolization group in terms of intraoperative estimated blood loss, total number of transfused packed red blood cell, calibrated estimated blood loss, operation time, and hospitalization time (P>0.05). Among the patients who underwent vertebral resection, intraoperative estimated blood loss, total number of transfused packed red blood cell and calibrated estimated blood loss were (1 966.7±898.8) ml, (7.42±3.27) U and (91.3±39.2) g/L in the embolization group, and (2 838.5±1 143.5) ml, (11.04±4.08) U and (133.0±46.4) g/L in the non-embolization group, respectively, with statistically significant differences (t=-2.107, -2.436, -2.419, P<0.05). However, there was no significant difference in the operation time and hospitalization time between the two subgroups (t=-0.780, -0.549, P>0.05). Among the patients who underwent laminectomy, there were no significant differences in the above-mentioned indicators between the embolization group and the non-embolization group (P>0.05). Conclusion Selective arterial embolization for spinal tumors is a relatively safe interventional procedure. Preoperative embolization does not significantly reduce the amount of blood loss during surgical procedures. After the surgical procedures were differentiated, preoperative embolization significantly reduces the amount of blood loss in patients underwent vertebral resection, while patients who underwent laminectomy do not benefit significantly.