Hepatic fibrosis is the most important pathologic course for chronic hepatic injury developing into hepatic cirrhosis. It is meaningful for treating liver disease by inhibiting the development of hepatic fibrosis. Recently, herbs of promoting blood circulation for removing blood stasis has their unique characteristics and exhibits great therapeutic effect on hepatic fibrosis. The review explains the function and mechanism of the promoting blood circulation for removing blood stasis herbs in treating hepatic fibrosis from the aspects of the monomer, effective constituent and compound recipe. It provides basis for application of promoting blood circulation for removing blood stasis herbs in study and treating hepatic fibrosis.

During the installation of a pipe pile, the soil around the pile will be squeezed out. This paper deals with this squeezing effect of open-ended pipe piles using the cylindrical cavity expansion theory. The characteristics of soil with different tension and compression modnli and dilation are involved by applying the elastic theory with different moduli and logarithmic strain. The closed-form solutions of the radius of the plastic region, the displacement of the boundary between the plastic region and the elastic region and the expansion pressure on the external surface of the pipe piles are obtained. When obtaining these solutions, the soil ping in the open-ended pipe pile is considered by employing an incremental filling ratio to quantify the degree of soil plugging. Moreover, the effects of the ratio of tension and compression moduli, angle of dilation and incremental filling ratio on the radius of the plastic region and the expansion pressure on the external surface of the pipe pile are investigated. The parametric analyses show that it is necessary and important to consider the difference between the tension modulus and compression modulus, dilation angle and incremental filling ratio for studying the squeezing effect of open-ended pipe pile installation. It is concluded that the analytical solutions presented in this paper are suitable for studying the squeezing effect of open-ended pipe piles.

Objective To evaluate the curative effects and safty of contra-aperture dissection and skin bridge preservation in the treatment of low transphincteric perianal fistula.Methods Sixty subjects of low transphincteric perianal fistula were randomly divided into two groups.Thirty cases of treatment group were treated by contra-aperture dissection and skin bridge preservation,and 30 cases of control group were treated by anal fistulectomy.On the second,seventh and fourteenth day after operation,the postoperative pain,exudate and fever were recorded and scored.The curative time was observed.Anorectal dynamic changes were compared simultaneously to evaluate the curative effects and safety of contra-aperture dissection and skin bridge preservation.Results The scores of pain and exudate were significantly different between the treatment and the control group(P＜0.01).The wound-healing time was shorter in the treatment group than that in the control group((27.37±8.93) d vs.(32.73±9.45) d,P=0.000).There were significant differences in the anal resting pressure,anal maximal contraction pressure and active systolic pressure between the two groups (t =13.12,10.21,12.10;P＜0.01).There was no significant difference of total effect between the two groups(100％ and 93.3％;x2 =2.07,P＞0.05).Conclusion Contra-aperture dissection and skin bridge preservation can reduce postoperative pain,exudate and fever,shorten wound-healing time and protect anal functions in the treatment of low transphincteric perianal fistula.

BACKGROUND:Periarticular multimodal drug cocktail injection for pain management after total knee arthroplasty (TKA) has been reported,but there are few studies concerning its effect on the range of motion and volume of drainage postoperative,and difference to nerve block.OBJECTIVE:To compare the analgesic effect of periarticular multimodal drug injection and nerve block in TKA.METHODS:Fifty-eight patients undergoing primary unilateral TKA in the First Affiliated Hospital of Anhui Medical University from 1 June 2016 to 31 October 2016 were randomly assigned to experimental and control groups (n=29 per group),followed by received a periarticular intraoperative injection of a 100 mL mixture containing ropivacaine,epinephrine,morphine,and normal saline,and preoperative combined femoral and sciatic nerve block,respectively.Subsequently,the Visual Analogue Scale scores,and range of motion,volume of drainage,hospitalization time,number of the patients given remedial analgesia and complications were compared between two groups.RESULTS AND CONCLUSION:(1) The Visual Analogue Scale scores at rest in the experimental group were significantly lower than those in the control group at 3 days after surgery (P ＜ 0.05).(2) The Visual Analogue Scale scores on movement in the experimental group were significantly lower than those in the control group at 1,2 and 3 days after surgery (P ＜ 0.05).(3) There were no significant differences in the range of motion,volume of drainage,hospitalization time and number of the patients give remedial analgesia between two groups postoperatively (P ＞ 0.05).(4) None appeared with obvious nausea,vomiting and other complications in the two groups.(5) These results indicate that the analgesic effect of periarticular multimodal drug injection is superior to nerve block,and the former is easy to operate,economical and practical.

Objective To analyze the related risk factors for delayed gastric emptying ( DGE) after pancreaticoduodenectomy .Methods Clinical data on 308 patients who underwent pancreaticoduodenectomy at Ningbo Lihuili hospital from January 2009 to December 2014 were retrospectively analyzed , and patients were divided into DGE group and non-DGE group.Univariate analysis and multivariate logistic regression analysis were used to study the risk factors associated with DGE during perioperative period .Results DGE occurred in 55 patients (17.9%).The incidences of grade A, grade B and grade C DGE were 7.1%(22/308), 6.2%(19/308) and 4.5%(14/308), respectively.The univariate analysis showed the method of pancreatic digestive tract reconstruction ( pancreaticogastrostomy or pancreaticojejunostomy ) , postoperative pancreatic fistula, postoperative biliary fistula and postoperative intraabdominal infection were risk factors for DGE after surgery. Multivariate analysis indicated that the method of pancreatic digestive tract reconstruction (OR=1.19, P=0.046), postoperative pancreatic fistula ( OR=1.33, P=0.014), postoperative biliary fistula (OR=1.43, P=0.047) and postoperative intraabdominal infection (OR=1.51, P=0.001) were independently associated with DGE . Postoperative pancreatic fistula (OR=3.692, P=0.021) and intraabdominal infection (OR=3.725,P=0.003)were also the independent risk factors for Grade B and Grade C DGE. Conclusions DGE after pancreaticoduodenectomy was strongly related to the postoperative complications .Postoperative pancreatic fistula , biliary fistula and intraabdominal infection were associated with increased risk of DGE , while pancreaticogastrostomy reduced the incidence of DGE by decreasing the incidence of pancreatic or biliary fistula .

Objective To evaluate the clinical value of MSCTA in displaying the right gastroepiploic artery(RGEA).Methods 16-slice spiral CT enhanced images of abdomen in 80 cases were retrospectively reviewed.The course and the length of RGEA were observed and the diameters of RGEA at the origin and the end were also measured on maximum intensity projection(MIP),thin slice maximum intensity projection(TSMIP) and volume rendering(VR) images.Results The displaying rate of RGEA by MSCTA was 100% including long type in 22 cases(27.50%),moderate type in 53 cases(66.25%) and short type in 5 cases(6.25%).The average length of RGEAs was (19.5±4.5) cm.The average diameters of RGEAs at the origin in long,moderate and short type respectively were (2.69±0.26) mm,(2.70±0.18) mm,(2.68±0.12) mm respectively.The average diameters of RGEAs at the end in these three types were (1.76±0.17) mm,(1.75±0.18) mm and (1.74±0.05) mm respectively.The average diameters of RGEA in different length were no of statistical significance(P＞0.05).Conclusion RGEA can be evaluated with MSCTA before coronary artery bypass grafting.

Hedgehog pathway is an osteogenesis-related signaling pathway . During embryonic development , it regulates the growth and proliferation of progenitor cells and tissue formation. This pathway can be activated during liver injury. Activated Hedge-hog signaling pathway is involved in many aspects of liver wound-healing responses, including hepatic progenitor cell pro-liferation, myofibroblast transdifferentiation, apoptosis of various types of liver cells, inflammatory reactions, and vascular remod-eling. This article reviews the research progress in the role of Hedgehog signaling pathway in liver injury and the underlying mechanisms. The potential drug targets are also discussed. This review is to provide novel insights into antifibrotic research and therapeutic targets.

OBJECTIVETo observe the impacts of different frequencies of electroacupuncture (EA) on post-operative cognitive function and the change in serum S-100beta protein under the compound anesthesia of acupuncture and drugs.

METHODSOne hundred and twenty-four patients of abdominal operation at selective time were randomized into a routine drug anesthesia group (group A, 24 cases), a meridian point 2 Hz group (group B, 26 cases), a me ridian point 2 Hz/100 Hz group (group C, 25 cases), a meridian point 100 Hz group (group D, 24 cases) and a transcutaneous acupoint electric stimulation 2 Hz/100 Hz group (group E, 25 cases). In group A, the endotrachea-lgeneral anesthesia was applied. In the rest groups, the acupuncture anesthesia was induced for 30 min before the endotracheal general anesthesia, at Baihui (GV 20), Yintang (GV 29) and Neiguan (PC 6), with G6805-2 electric acupuncture apparatus used. In group B, the continuous wave and 2Hz in frequency were selected. In group C, the disperse-dense wave and 2 Hz/100 Hz in frequency were selected. In group D, the continuous wave and 100 Hz in frequency were selected. In group E, the disperse-dense wave and 2 Hz/100 Hz in frequency were selected, and the electrode pads were stick on the acupoints and connected with the electric stimulation till the end of operation. Mini-mental state examination (MMSE) was adopted to evaluate and record the changes in cognitive function 1 day before operation and on the 3rd day after operation. The conditions of post-operative cognitive dysfunction (POCD) in the patients and the changes in serum S-100beta protein were monitored before and at the end of operation.

RESULTSThe incidence rate of POCD on the 3rd day after operation was 41.7% (10/24) in group A. The incidence rates of POCD were 26.9% (7/26), 16.0% (4/25), 33.3% (8/24) and 16.0% (4/25) in group B, C, D and E separately. Compared with group A, the incidence rate of PCOD in group B, C, D and E were reduced (all P<0.05), the incidence rate in group C and E were lower than that in groups B and D (all P<0.05). At the end of operation, the level of serumS-100beta protein was (0.186 +/- 0.027) microg/L in group A, the levels were (0.165 +/- 0. 028) microg/L, (0.166 +/- 0.027) microg/L, (0.163 +/- 0.025) microg/L and (0.164 +/- 0.025) microg/L in group B, C, D and E separately. The levels of serum S-100beta protein in group B, C, D and E were lower than that in group A separately (all P<0.05).

CONCLUSIONThe general anesthesia assisted with EA at different frequencies reduces the incidence of cognitive dysfunctionand, decreases the level of serum S-100beta protein after intestinal cancer resection. The effects of the meridian point electric stimulation at 2 Hz/100 Hz and the transcutaneous electric stimulation at 2 Hz/100 Hz are the best. Hence, these two approaches of anesthesia deserve to be recommended practically.

Abdomen ; surgery ; Acupuncture Analgesia ; Aged ; Aged, 80 and over ; Anesthesia, General ; Cognition ; drug effects ; Electroacupuncture ; Female ; Humans ; Male ; Postoperative Period

Objective To explore the effect of workshop on postoperative function of affected limb in patients with breast cancer. Meth-ods From August, 2015 to June, 2016, 70 patients with breast cancer after modified radical mastectomy were randomly divided into control group (n=35) and observation group (n=35). The control group was instructed by the primary nurse bedside based on the traditional method, while the observation group was guided with workshop mode. Results Ten days and one month after surgery, the range of motion of the shoulder joint in the observation group was superior to the control group (t>2.030, P<0.01);the incidence of lymphedema of the affected limb in the observation group was lower than that in the control group (u=2.195, P<0.05). Conclusion Functional exercise guided with work-shop mode could improve postoperative function of affected limb in patients with breast cancer.

Objective To evaluate the feasibility and outcome of laparoscopic cholecystectomy as a overnight procedure in China.Methods The data of 59 consecutive patients who had undergone outpatient laparoscopic cholecystectomy between Januaiy 2013 and January 2015.All the patients were operated in the morning hours and discharged during 24 hours after operation.They were contacted by telephone 3 days subsequent to surgery and were seen in the outpatient unit 7 days after.Results Fifty-nine laparoscopic cholecystectomies were performed.No Conversion to open surgery case.The average operation time was 25 minutes,and restore semi-liquid diet 6 hours after the operation All the 59 patients were discharged during 24 hours after operations.None of the patients had an emergency readmission.None of the patients had complications 7 days after discharged.The average payment was 8 240 yuan.Conclusion These results suggest that laparoscopic cholecystectomy can be routinely performed as a overnight procedure.