Objective: To evaluate the significance of occlusion of hemihepatic inflow plus major ipsilateral hepatic veins in anatomic hepatectomy. Methods: One hundred and two cases were divided into 3 groups for anatomic hepatectomy: Group A (hemihepatic inflow plus major hepatic vein occlusion, n=42), Group B (hemihepatic inflow occlusion, n=30)and Group C (Pringle maneuver, n=30). The amount of intraoperative bleeding, time of operation, postoperative liver function, liver function recovering and complications were compared. Results: The average amount of hemorrhage in Group A, Group B and Group C were(453.5?87.9)、(612.8?101.6)and(646.7?136.6)mL, respectively. The mean blood loss in Group A was significantly more than that in Group B and Group C (P0.05). The levels of serum alanine transaminase (ALT)and bilirubin of 3rd and 6th day of postoperation in Group A and Group B were significantly lower than that in Group C, while the level of serum albumin in Group A and Group B was significantly higher than that in Group C(P0.05). Incidence of ascites in Group C was significantly higher than in Group A and Group B (P

OBJECTIVE: To study the effects of resolving stagnation and promoting granulation therapy on expressions of Bax and Bcl-2 in granulation tissue of diabetic rats during wound healing. METHODS: Seventy-two male SD diabetic rats with full-thickness skin lesion were randomly divided into 3 groups: SJHYR 1-treated group, SJHYR 2-treated group and normal saline (NS) control group. SJHYR 1 was prepared with Shengji Recipe (SJR, a compound traditional Chinese herbal medicine for promoting granulation) and Huayu Recipe (HYR, a compound traditional Chinese herbal medicine for resolving stagnation) at a ratio of 1:2, while SJHYR 2 was prepared with SJR and HYR at a ratio of 1:1. Immunohistochemical method was used to assess Bax and Bcl-2 protein levels in granulation tissue. RESULTS: SJHYR 1 could accelerate wound healing as compared with SJHYR 2 and NS (P<0.05). On the third day in experiment, Bax and Bcl-2 proteins were not found in any groups, but on the seventh and eleventh day in experiment, Bax and Bcl-2 proteins in SJHYR 1-treated group were much higher than those in the other two groups (P<0.05). CONCLUSION: SJR and HYR in different ratios may all have a role in regulating Bax and Bcl-2 expression in granulation tissue of diabetic rats during wound healing.

Objective To evaluate the effect of electro-acupuncture (EA) at Zusanli (ST36) acupoint on blood coagulation during intestinal ischemia-reperfusion (I/R) in rats.Methods Forty healthy male Sprague-Dawley rats,aged 6-8 months,weighing 250-300 g,were divided into 5 groups (n =8 each) using a random number table:sham operation group (group S),intestinal I/R group (group I/R),EA at Zusanli acupoint group (group EA),EA at non-acupoint group (group NE) and α7 nicotinic acetylcholine receptor antagonist α-bungarotoxin (α-BGT) group (group α-BGT).Intestinal I/R was induced by clamping the superior mesenteric artery for 4-5 min followed by 120 min of reperfusion.Bilateral Zusanli acupoints were stimulated with an electric stimulator (frequency 3 Hz,voltage 2-4 V,wave length 2 ms) for 30 min starting from the time point immediately after beginning of ischemia in group EA,while EA was performed at the points 5 mm lateral to the bilateral Zusanli instead in group NE.In group α-BGT,α-BGT 1 μg/kg was intraperitoneally injected at 45 min before ischemia,and the other treatments were similar to those previously described in group EA.Blood samples were collected from the abdominal aorta at 120 min of reperfusion for determination of the concentrations of tumor necrosis factor alpha (TNFα),tissue factor (TF),antithrombin (AT),tissue plasminogen activator (tPA),fiber plasminogen activator inhibitor-1 (PAl-l) and D-dimer in plasma (by enzyme-linked immunosorbent assay) and platelet count (PLT).The animals were sacrificed after blood sampling,the distal ileum specimens were removed for examination of the pathological changes with a light microscope,and the damage to the intestinal mucous membrane was assessed and scored according to Chin.Results Compared with group S,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly increased,and the plasma AT concentration and PLT were decreased in I/R,NE and α-BGT groups,the concentrations of plasma TNFα and TF were significantly increased,and the plasma AT concentration was decreased in group EA,and Chiu's scores were significantly increased in I/R,EA,NE and α-BGT groups (P＜ 0.05).Compared with group I/R,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly decreased,the plasma AT concentration and PLT were increased,and Chiu's scores were decreased in group EA (P＜0.05),and no significant change was found in the variables mentioned above in NE and α-BGT groups (P＞0.05).Compared with group EA,the concentrations of plasma TNFα,TF,tPA,PAI-1 and D-dimer were significantly increased,the plasma AT concentration and PLT were decreased,and Chiu's scores were increased in group NE (P＜0.05).Conclusion EA at Zusanli acupoint can improve blood coagulation during intestinal I/R in rats,and the mechanism is related to activating the cholinergic anti-inflammatory pathway.

Background: Anal fissure is one of the most common anal-rectum diseases, and approximately 10 percent patients with chronic anal fissure ultimately receive surgery. Relieving postoperative pain and protecting functions of the sphincter are central issues for coloproctologists. Objective: To evaluate the efficacy and safety of anoplasty in the treatment of chronic anal fissures. Design, setting, participants and interventions: In this prospective, multicenter, randomized controlled trial, 120 adult patients with chronic anal fissure were referred from Department of Coloproctology of Yueyang Hospital of Integrated Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Shanghai Municipal Hospital of Traditional Chinese Medicine. The patients were enrolled from January 2009 to April 2010 and randomly divided into study (mucosa advancement flap anoplasty, abbreviated as anoplasty) group and control (fissurectomy) group. The two groups were assessed separately, and the main outcome measures were observed for 2 weeks, with a short-term follow-up for 6 weeks. Main outcome measures: Degree of pain, haemorrhage and anal canal pressure were observed and recorded preoperatively, and on the third day, the fourteenth day and the sixth week postoperatively. The wound healing time was also recorded. Surgical complications of the two groups were recorded and compared on the third day and the sixth week postoperatively. The curative effects associated with the surgery were analyzed on the fourteenth day and the sixth week after surgery and the therapeutic results were evaluated. Results: Three patients were dropped out due to the early discharge from hospital and losing connection (1 in study group and 2 in control group). Overall the surgery showed that the anoplasty group had better results than the fissurectomy group in the curative effect on the sixth week after operation (P<0.05). Time of wound healing in the anoplasty group was (17.22±4.41) d and was better than (21.24±7.44) d of the fissurectomy group (P<0.05). Concerning the relief of wound pain, the anoplasty group achieved better results than the fissurectomy group at the third day, the fourteenth day and the sixth week after operation (P<0.05). Anoplasty reduced bleeding and had better efficacy than the fissurectomy at the third day and the fourteenth day after operation (P<0.05), however, there was no statistical difference at the sixth week after operation (P>0.05). There were no significant differences in relieving the anal canal pressure (P>0.05) and the surgical complications (dysuria, edema of anal margin, fever, infection, anal incontinence and anal deformation) between the two groups (P>0.05). None of the patients suffered postoperative complications by the sixth week after operation. Furthermore, there was no recurrence in either of the two groups at six weeks after operation. Conclusion: The results indicate that anoplasty for chronic anal fissures has advantages such as better therapeutic effects, less postoperative pain, a shorter healing time and no incidence of anal incontinence.

Objective To investigate the clinicopathological factors associated with pathological complete response(pCR)of axillary metastatic lymph nodes in breast cancer patients after neoadjuvant chemotherapy(NAC),and to analyze the postoperative survival.Methods A total of 116 patients with breast cancer with axillary lymph node metastasis were collected from Jiaxing Hospital of TCM,Jiaxing Maternity and Child Health Care Hospital and The First Hospital of Jiaxing.Univariate analysis was used to analyze the relationship between clinicopathological factors and the pCR of axillary lymph node metastasis in breast cancer after NAC.Binary Logistic regression was used to analyze the independent predictors of the pCR of axillary lymph node metastasis in breast cancer after NAC.Kaplan-Meier survival curve was used to analyze the disease-free survival rate and overall survival rate of patients with and non-pCR of axillary metastatic lymph nodes.Results Among 116 patients,52 cases of axillary metastatic lymph nodes achieved pCR after NAC,accounting for 44.83%.Univariate analysis showed that age,vascular invasion,pCR of primary breast tumor,the difference of Ki67 before and after NAC,NAC regimen,and the efficacy of NAC were statistically significant between breast cancer patients with pCR and those non-pCR(P<0.05).Binary Logistic regression analysis showed that age,vascular invasion and pCR of primary breast tumor were independent predictors of pCR of axillary metastatic lymph nodes(P<0.05).The 5-year disease-free survival rate(80.40%vs.54.60%)and overall survival rate(90.4%vs.70.10%)of patients with pCR and non-pCR of axillary metastatic lymph nodes were compared.Conclusion Some breast cancer patients with axillary lymph node metastasis can reach pCR in lymph nodes after NAC.Analyzing the correlation between clinical pathological factors and pCR of axillary metastatic lymph nodes after NAC,it was found that pCR of axillary metastatic lymph nodes after NAC is related to age≤50 years old,no vascular infiltration,and primary breast tumor pCR.At the same time,it was found that patients with axillary metastatic lymph node pCR had a better prognosis than those with non-pCR.