Objective To investigate the clinical manifestation and management of acute cholangitis severe type (ACST) with different typos of obstruction. Methods From January 1997 to December 2006, 164 consecutive patients with ACST had been admitted to Chengdu First People's Hospital. All patients were divided into extrahepatic type group (n=122), intrahepatic type group (n=18) and mixed type group (n=24) accord-ing to the types of obstruction. Clinical manifestation and therapeutic outcome of the 3 groups were analyzed using chi-square test, continuity correction test or Fisher exact test. Results There was no significant difference in clinical manifestation between patients with extrahepatic type and those with mixed type (P>0.05). The incidence of jaundice and abdominal pain in patients with intrahepatic type is significantly lower than those with extrahepatic type (P<0.05). The incidences of distention in consciousness and response to initial medical treat-ment were higher than those with extrahepatic type (P<0.05). The total mortality rate was 9.8% (16/164). Of all patients, 123 received open surgery. There was no significant difference in morbidity and mortality in patients with intrahepatic type and mixed type (χ~2=0.172,0.789; 1.769, 1.948, P>0.05). In emergency operation, the incidence of biliary high pressure and postoperative vital sign improvement rates were significant higher in patients with extrahepatic type than the other 2 types (P<0.05). The morbidity and mortality of patients who received emergency operation were higher than non-emergency operation (P<0.05). Conclusions The clinical manifestation of ACST is different between intrahepatic obstructive type and the other 2 types. There is no signi-ficant difference in morbidity and mortality among the 3 types of obstruction. The morbidity and mortality are high in patients who received emergency operation. Proper management of surgical timing is helpful in decreasing the morbidity and motality of ACST.

Objective To explore the application values and the effect of myocardial preservation of right stellate ganglion block in off-pump coronary artery bypass grafting (OPCABG). Methods Sixty-two patients with ASA Ⅱ or Ⅲ,aged 50-75 years,scheduled for OPCABG were randomly divided into stellate ganglion block group (group SGB)and control group (group C)with 31 cases each.The patients in group SGB received right-lateral SGB before anesthesia induction.The medications and methods of anesthesia induction in the two groups were identical.Hemodynamics be-fore start of anethesia (T0 ),after induction (T1 ),after intubation tube (T2 ),after sternotomy (T3 ),at the beginning of bypass surgery for interrupted coronary artery (T4 ),at the end of coronary bypass grafting (T5 )were observed.Meanwhile,changes of serum cardiac troponin I (cTnI)and cre-atine phosphokinase MB (CK-MB)at T0 ,6 h (T6 ),12 h (T7 ),24 h (T8 )after operation were also observed.The operative time,the amount of drugs used and postoperative recovery were recored. Results MAP,HR of group SGB increased at T2-T5 compared with T0 ,and MAP,HR of group C significantly increased at T2-T5 comparing with T0 (P <0.05).Compared with those in group SGB, MAP,HR significantly increased at T2-T5 in group C (P <0.05 ).The Concentrations of cTnI and CK-MB of group C increased more obviously than those in group SGB at T6-T8 (P <0.05).Compared with group C,patients in group SGB needed less medication,less hospitalization time in ICU and had faster postoperative recovery.Conclusion SGB for patients during OPCABG stabilizes hemodynamy stability,further reduces myocardial injury,thus protecting myocardium.

Objective To determine the effects of high-frequency jet ventilation (HFJV) on oxidative stress in patients during one-lung ventilation (OLV). Methods Forty-five patients undergoing elective radical esophageal cancer resection were divided into three groups with 15 cases each by random digits table: two lung ventilation group ( group A), OLV group (group B), HFJV- OLV group ( group C, working pressure 1 kg/cm2 and frequency 100 times/min). Venous blood samples were taken before induction (T0),at30min (T1),90min (T2),150min (T3) after OLV and the end of operation (T4) for measuring serum superoxide dismutase(SOD),malondialdehyde (MDA) and nitric oxide (NO). Results SOD was lower at T2-T4 in group B[(47 ± 10), (37 ±9), (41 ±7) kU/L] and group C[(58 ± 12), (51 ± 11), (49 ± 9) kU/L] than those in group A [(78 ±8), (75 ±7), (79 ±6) kU/L](P＜ 0.05),and MDA and NO were lower at T1-T4 in group B and group C than that in group A(P＜ 0.05). SOD was higher at T3 in group C than that in group B (P ＜ 0.05), MDA at T1-T4 and NO at T2-T4 were lower in group C than those in group B (P ＜ 0.05). Conclusion HFJV can effectively decrease oxidative stress in patients during OLV.

Objective To comparO thO Officacy and safOty of concurrOnt chOmoradiothOrapy and sOquOntial chOmoradiothOrapy in thO trOatmOnt of locally advancOd non -small cOll lung cancOr ( NSCLC). Methods From SOptOmbOr 2016 to FObruary 2018, 88 patiOnts with locally advancOd NSCLC admittOd to Li Huili East Hospital wOrO randomly dividOd into synchronous group ( 45 casOs) and sOquOntial group ( 43 casOs). ThO synchronous group rOcOivOd concurrOnt radiothOrapy and chOmothOrapy, whilO thO sOquOntial group was givOn radiothOrapy aftOr 4 cyclOs of chOmothOrapy. Both two groups took thO samO radiothOrapy and chOmothOrapy prOscription. ThO clinical Officacy, advOrsO rOactions and quality of lifO of thO two groups wOrO comparOd.Results ThO total OffOctivO ratO in thO synchro-nous group was significantly highOr than that in thO sOquOntial group (6.22% vs. 39.53% , χ2 =4.530,P<0.05). ThO incidOncO ratO of Ⅰ ~Ⅱ gradO radiation lung injury and radiation Osophagitis in thO synchronous group wOrO significantly highOr than thosO in thO sOquOntial group (26.67% vs. 9.30% ;17.78% vs. 2.32% , χ2 =4.457, 4.159,all P<0.05).ThOrO was no statistically significant diffOrOncO in quality of lifO scorO bOtwOOn thO two groups bOforO trOatmOnt (P>0.05).ThO body hOalth and total hOalth status of thO synchronous group wOrO significantly lowOr than thosO of thO sOquOntial group at thO Ond of trOatmOnt [(66.48 ± 9.28) points vs.(70.95 ± 11.68) points;(51.48 ± 10.26)points vs.(55.42 ± 9.84)points, t=2.010,2.144,all P<0.05], but thO scorO of total hOalth status in thO synchronous group was significantly highOr than that in thO sOquOntial group at thO Ond of trOatmOnt [(61.28 ± 6.48)points vs.(57.83 ± 7.93)points, t=2.239,P<0.05].Conclusion ConcurrOnt chOmoradiothOrapy has bOttOr clinical Officacy than sOquOntial radiothOrapy and chOmothOrapy in thO trOatmOnt of locally advancOd NSCLC. Although it can incrOasO thO incidOncO of radiation pnOumonitis and Osophagitis, thO patiOnts arO wOll tolOratOd and thO quality of lifO is improvOd gradually at thO Ond of thO trOatmOnt. It is worthy of clinical promotion.

Objective: To observe the pharmacodynamic effect of Xiaobanxia Decoction (XBXD) and categorized formula on cisplatin-induced delayed chemotherapeutic vomiting in rats, and to explore its prevention and treatment mechanism. Methods: Sixty Wistar rats were randomly divided into blank group, model group, ondansetron group, XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder group, with 10 rats in each group. The ondansetron group was given 2.6 mg/(kg•d) ondansetron, the XBXD group was given XBXD 22 g/(kg•d), the Ginger Pinellia Decoction group was given 31.5 ml/(kg•d) Ginger Pinellia Decoction, and Pinellia and Dried Ginger Powder group was given 0.63 g/(kg•d) Dried Ginger Powder. The blank group and the model group were intragastrically administered with normal saline. All the treattmens were last for three days and twice per day. After the first administration, except the blank group, the rats in all groups were intraperitoneally injected with 6 mg/kg cisplatin to establish chemotherapy-induced vomiting model. The kaolin intake of the chemotherapical rats were weighed every 24 h, and the ileum and medulla 5-HT, 5-HIAA, TPH and MAOA levels were detected by ELISA. Results: Compared with the model group, the kaolin intake of the chemotherapy rats in each treatment group significantly decreased (P<0.05). The levels of ileum 5-HT (308.04 ± 29.90 ng/L, 355.97 ± 19.16 ng/L, 389.97 ± 24.86 ng/L vs. 498.95 ± 13.92 ng/L) and medulla 5-HT (375.32 ± 19.33 ng/L, 395.18 ± 16.12 ng/L, 406.68 ± 12.09 ng/L vs. 478.52 ± 13.88 ng/L) in the XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased (P<0.05). The levels of ileum TPH (35.14 ± 2.68 ng/L vs. 47.31 ± 0.83 ng/L) in the XBXD group significantly decreased (P<0.05). The levels of medulla TPH (33.68 ± 2.79 ng/L, 38.19 ± 1.74 ng/L vs. 43.68 ± 1.53 ng/L) in the Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased (P<0.05). The levels of MAOA, 5-HIAA in the ileum and medulla of the XBXD group, Ginger Pinellia Decoction group and Pinellia and Dried Ginger Powder significantly decreased (P<0.05). Conclusions XBXD and categorized formula can effectively prevent and treat delayed chemotherapy-induced vomiting in rats, and its mechanism may be related to decrease the TPH level and inhibiting 5-HT synthesis.

Objective To establish and evaluate chemotherapeutic phlebitis model rats induced by vinorelbine via the dorsalis pedis vein.Methods Rats were divided randomly into control and 4 different concentration of vinorelbine-induced model groups.Control rats were injected with 0.1 mL normal saline via the dorsalis pedis vein of the hind limb,while other rats were injected with different concentrations of vinorelbine(2,3,4,5 mg/mL),as above.General observations were performed and the hind limb volume was measured daily for 7 consecutive days to calculate the swelling rate.The rats were then killed and histological changes in the dorsalis pedis vein were observed by hematoxylin and eosin staining.Microstructural changes on the surface of the vascular endometrium were observed by scanning electron microscopy.Results Injection of 2,3,4,5 mg/mL vinorelbine via the dorsalis pedis vein significantly induced hind limb swelling in a concentration-dependent manner,peaking on day 3 in each group.The phlebitis rates on day 7 were 50%in the 2 mg/mL group and 83.3%in the 3 mg/mL group.Phlebitis was also induced in the 4 mg/mL and 5 mg/mL groups,including grade Ⅲ in 66.6%and grade Ⅳ in 83.3%.Histopathology showed inflammatory cell infiltration,wall thickening,lumen stenosis,and thrombosis in the tissues surrounding the veins.Scanning electron microscopy showed destruction of tight junctions of venous endothelial cells,and a rough surface of the vascular lining,resultsing in blood cell adhesion.Conclusions Injection of 0.1 mL of 3～5 mg/mL vinorelbine via the dorsalis pedis vein could induce red,swollen,and cord-like veins,as well as infiltration of inflammatory cells around the vein,thickened vein walls,lumen stenosis,and thrombosis.In addition,the surface of the venous intima was rough and adhered to numerous blood cells.All these features are consistent with those of clinical chemotherapeutic phlebitis in terms of the symptoms and pathological structure.

Objective To explore the incidence of pain flare (PF) in spine metastasis stereotactic body radiotherapy (SBRT) or hypofractionated radiotherapy (HF) and the prophylactical effect of dexamethasone. Methods Sixty-five patients were treated with spine metastasis SBRT and randomly divided into control group (SBRT or HF, n=32) and treatment group (SBRT or HF and 4.5 mg dexamethasone, n=33). The brief pain inventory (BPI) was used to score the pain before, during and after treatment. PF was recorded and compared between two groups. Results The incidence of PF was 24.6% in all patients (control group: 37.5%, treatment group: 12.1%, P=0.018). PF in both group occurred in d1-2, accounting for 62.5% in all PF (control group: 66.7%, treatment group: 50%, P=0.551). The incidences of PF in control group were 66.7% and 33.3% for three and ten fractions scheme, respectively (P=0.001). However, the incidences of PF in treatment group were 50% and 50% for three and ten fractions scheme, respectively (P=0.643). Conclusion Oral dexamethasone has an excellent efficacy in prevention and treatment of PF in spine metastasis SBRT or HF, with significantly decreased incidence of PF. A phase Ⅲ clinical trial is required to finalize the optimal dose and schedule.

Objective:To investigate the safety and utility of using polyester spacers in conventional pancreatico-enteric anastomosis in pancreaticoduodenectomy to achieve prevention of postoperative pancreatic fistula.Methods:The clinical data of 82 patients with pancreaticoduodenectomy completed by the same physician in Anyang People's Hospital from August 2018 to August 2023 were retrospectively analyzed, including 52 males and 30 females, aged (62.21±9.75) years. They were divided into two groups, test group ( n=40) and control group ( n=42) according to whether polyester spacers were used in pancreatico-intestinal anastomosis, the perioperative data of the two groups were compared, and Logistic analysis was used to analyze the risk factors affecting postoperative pancreatic fistula. Results:There was no statistically significant difference between the two groups in terms of biliary fistula, intestinal fistula, abdominal infection, abdominal bleeding, and postoperative mortality rate (all P>0.05). The incidence of postoperative pancreatic fistula in the test group was 20.0% (8/40) which was lower than that in the control group 45.2% (19/42), and the difference was statistically significant ( P=0.015). Soft pancreas texture ( OR=16.595, 95% CI: 1.891~145.657) was an independent risk factor for postoperative pancreatic fistula, while improved pancreatic enterostomy with polyester spacers ( OR=0.332, 95% CI: 0.114~0.969) could reduce the risk of postoperative pancreatic fistula. Conclusion:Use of polyester spacers to reinforce the pancreatico-enteric anastomosis during pancreaticoduodenectomy reduces the incidence of postoperative pancreatic fistulae with good safety and practicality.

Objective:To investigate the clinical effect of thin superficial inferior epigastric artery flaps in repairing soft tissue defects after buccal cancer surgery.Methods:From January 2018 to October 2019, 6 patients with buccal cancer who underwent surgery were constructed with thin superficial inferior epigastric artery flaps, including 2 males and 4 females, aged 43 to 68 years, with an average of 61.5 years. Doppler ultrasound was utilized of all patients to design flap preoperatively . According to the size of the affected area defect, according to the shape and direction of the blood vessels, a thin superficial inferior epigastric artery flap was elevated above the Scarpas fascia layer and transferred to repair soft tissue defects after buccal cancer surgery. The survival and functional recovery of the flap were observed.Results:All 6 flaps survived. The superficial inferior epigastric artery flaps ranged from 5.0 cm×7.0 cm to 7.0 cm×9.0 cm. The thickness of the flaps ranged from 0.5 cm to 1.3 cm, and the average thickness was 0.8 cm. The pedicle length is 6.0-9.0 cm.Four of them anastomosed to the superficial inferior epigastric veins and companion vein, 2 cases only anastomized superficial inferior epigastric veins . The follow-up period ranged from 3 to 12 months, with an average of 10 months. The cheek shape was good, the mouth opening was normal, there was no obvious bloating, and no secondary surgery was required. Linear scars were left on the donor site, with concealed location and no impairment of abdominal wall function.Conclusions:The donor site of the thin superficial inferior epigastric artery flap is small, the scar is concealed, the cheek is not bloated, and the opening degree of mouth is satisfactory. It is a good choice for reconstructing postoperative defect of cheek cancer.

Objective:The aim of this study was to explore the application of maxillary osteotomy plate and positioning guide plate in maxillary Le Fort Ⅰ osteotomy to eliminate the postoperative error caused by condylar displacement.Methods:Patients suffered from skeletal malocclusion and needed Le Fort Ⅰ osteotomy between January 2018 and November 2020 were selected from the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College. All patients were scanned with 64 slice spiral CT. The DICOM format data were analyzed using the Simplant software to reconstruct the virtual three-dimensional model of the jaw before operation. Then, the measurement of indexes and the maxillary Le Fort Ⅰ osteotomy were carried out on the virtual three-dimensional model, respectively. 3D-printed osteotomy guide plate and positioning guide plate were used to determine the osteotomy line and the position of maxillary advancement. 3D-printed tooth supported occlusal plate was used to support the mandibular sagittal split and retraction. The differences of 10 indexes between the two groups (virtual operation and surgery) were analyzed by paired t test using SPSS 22.0. Results:A total of 8 patients (5 males and 3 females) needed maxillary Le Fort Ⅰ osteotomy aged from 18 to 39 years old were recorded. The deviation of age in these patients was 24.8. The 3D-printed guide plate and tooth supporting occlusal plate were positioned accurately in surgery. All the operations were successful with primary healing of the incision and stable occlusion, and without joint clicking. There was no significant difference on the 10 indexes between the groups of virtual operation and surgery ( P>0.05). Conclusions:The application of maxillary osteotomy plate and positioning guide plate can effectively and accurately control the three-dimensional movement of the maxilla and improve the precision of maxillary Le fort Ⅰ osteotomy in orthognathic surgery, making the surgical effect highly consistent with the preoperative design.