Polygonatum sibiricum polysaccharide(PSP)is a polysaccharide with multiple pharma-cological activities that has been widely studied and used in the human body.However,there is cur-rently a lack of research investigating the potential advantages of PSP in poultry farming.This study investigated the effects of adding PSP to drinking water on the growth performance,antioxi-dant status,serum biochemical indicators,ileal tissue morphology,immune organs,and intestinal function of chicks.88 Hailan brown laying hens were randomly divided into 4 groups,with 22 hens in each group,namely the blank control group(CON),and fed with basic feed;The low-dose PSP group(250 mg/L),the medium dose PSP group(500 mg/L),and the high-dose PSP group(1 000 mg/L)were fed with corresponding doses of PSP through drinking water on the basis of basic feed,and the experimental period was 21 d.The initial and final body weight and immune or-gan relative quality of chicks,serum biochemical indicators,the activities of SOD,CAT,and GSH-Px,as well as the contents of T-AOC and MDA in the serum of chicks were measured;HE stai-ning method was used to observe the pathological changes of intestinal tissue slices in the ileum;Real time fluorescence quantitative PCR technology was used to detect the mRNA expression lev-els of cytokines ZO-1,Claudin-1,Occludin,Mucin-2,IL-1β,TNF-a,IFN-γ,IL-4,IL-8,and IL-10 in the ileum.The results showed that compared with the blank control group,the addition of medium dose PSP significantly increased the final relative quality(P＜0.01),the final body weight and ADG of PSP500 group chicks significantly increased(P＜0.01),and the F/G of PSP250 and PSP500 groups significantly decreased(P＜0.05 or P＜0.01).The villus height of the jejunum in the 200,500,and 1 000 mg/L PSP groups of chicks significantly increased(P＜0.05).The SOD ac-tivity significantly increased(P＜0.01),and the CAT activity in the PSP1000 group significantly increased(P＜0.01).The PSP500 and PSP1000 groups significantly reduced the mRNA expression of cytokines IL-1β,IL-4,and IFN-γ in the ileum(P＞0.05);PSP did not show significant changes in serum total protein(TP),albumin(ALB),glucose(GLU),cholesterol(T-CHO)content,and immune organ index(P＜0.05).In summary,PSP can improve growth performance,enhance an-tioxidant capacity,improve ileal morphology and epithelial barrier function,and regulate mucosal immune status.Considering the overall economic benefits,the recommended level of PSP addition is 500 mg/L.

Polygonatum sibiricum polysaccharide(PSP)is a polysaccharide with multiple pharma-cological activities that has been widely studied and used in the human body.However,there is cur-rently a lack of research investigating the potential advantages of PSP in poultry farming.This study investigated the effects of adding PSP to drinking water on the growth performance,antioxi-dant status,serum biochemical indicators,ileal tissue morphology,immune organs,and intestinal function of chicks.88 Hailan brown laying hens were randomly divided into 4 groups,with 22 hens in each group,namely the blank control group(CON),and fed with basic feed;The low-dose PSP group(250 mg/L),the medium dose PSP group(500 mg/L),and the high-dose PSP group(1 000 mg/L)were fed with corresponding doses of PSP through drinking water on the basis of basic feed,and the experimental period was 21 d.The initial and final body weight and immune or-gan relative quality of chicks,serum biochemical indicators,the activities of SOD,CAT,and GSH-Px,as well as the contents of T-AOC and MDA in the serum of chicks were measured;HE stai-ning method was used to observe the pathological changes of intestinal tissue slices in the ileum;Real time fluorescence quantitative PCR technology was used to detect the mRNA expression lev-els of cytokines ZO-1,Claudin-1,Occludin,Mucin-2,IL-1β,TNF-a,IFN-γ,IL-4,IL-8,and IL-10 in the ileum.The results showed that compared with the blank control group,the addition of medium dose PSP significantly increased the final relative quality(P＜0.01),the final body weight and ADG of PSP500 group chicks significantly increased(P＜0.01),and the F/G of PSP250 and PSP500 groups significantly decreased(P＜0.05 or P＜0.01).The villus height of the jejunum in the 200,500,and 1 000 mg/L PSP groups of chicks significantly increased(P＜0.05).The SOD ac-tivity significantly increased(P＜0.01),and the CAT activity in the PSP1000 group significantly increased(P＜0.01).The PSP500 and PSP1000 groups significantly reduced the mRNA expression of cytokines IL-1β,IL-4,and IFN-γ in the ileum(P＞0.05);PSP did not show significant changes in serum total protein(TP),albumin(ALB),glucose(GLU),cholesterol(T-CHO)content,and immune organ index(P＜0.05).In summary,PSP can improve growth performance,enhance an-tioxidant capacity,improve ileal morphology and epithelial barrier function,and regulate mucosal immune status.Considering the overall economic benefits,the recommended level of PSP addition is 500 mg/L.

Objective:To study the causes of hemorrhage after laparoscopic pancreaticoduodenectomy (LPD) and to develop countermeasures in its prevention.Methods:The clinical data of 215 patients who underwent LPD at the Department of Hepatobiliary and Pancreatic Surgery of Zhejiang Provincial People's Hospital from December 2013 to May 2020 were reviewed. The patients’ clinical data including gender, age, comorbidities and postoperative complications such as bleeding, pancreatic fistula, biliary fistula and intraperitoneal infection were studied, with the aims to analyze the causes, clinical manifestations and treatment results of post-pancreaticoduodenectomy hemorrhage (PPH) after LPD.Results:Of 215 patients, there were 132 males and 83 females, aged (60.7±10.3) years. PPH occurred in 20 patients, incidence rate was 9.30%(20/215). Early hemorrhage was mainly caused by inadequate hemostasis or loosening of vascular clips, while delayed hemorrhage was mainly caused by gastrointestinal fistula with vascular erosion, arterial injury by intraoperative energy instruments or pseudoaneurysms. Among the 20 patients, 6 patients had early hemorrhage and 14 delayed hemorrhage. There was 1 patient with grade A, 10 with grade B and 9 with grade C hemorrhage. Thirteen patients developed pancreatic fistula, 1 biliary fistula, and 2 intraperitoneal infection. One patient responded well to conservative treatment. Hemostasis was successfully achieved by gastroscopy ( n=1) and interventional therapy ( n=7). Eleven patients required laparotomy for hemostasis. In this study, 14 of 20 patients survivied PPH and 6 patients died. The mortality rate was 30% (6 of 20 patients with PPH). Conclusions:Early hemorrhage was caused by inadequate hemostasis or loosening vascular clips, while delayed hemorrhage was related to gastrointestinal fistula with vascular erosion, arterial injury by intraoperative energy instrument or pseudoaneurysm. Careful hemostasis, adequate protection of blood vessels, and accurate anastomosis should be performed in LPD. DSA angiography should be used for arterial hemorrhage which progressed very rapidly. Interventional therapy including embolism and stenting were means to control arterial bleeding in PPH. Decisive surgical exploration when interventional therapy failed was important in reducing the mortality rate of these patients.

Objective:To study the technical and essential steps in laparoscopic selective devascularization with paraesophageal veins-preservation.Methods:To retrospectively analyze the clinical data of 13 cirrhotic patients who underwent laparoscopic selective pericardial devascularization for portal hypertension at the Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital from January 2019 to March 2020. There were 9 males and 4 females with age ranging from 41 to 83 years (median 51 years). The operative time, intraoperative blood loss, postoperative complications and follow-up data were analyzed.Results:All the 13 patients completed theoperation, no patient stopped the operation or transferred to laparotomy. The operation time was (170±32) min.The intraoperative bleeding was (160±30) ml. The postoperative hospital stay was (6.1±1.1) days. There were no complications, including pancreatic leakage and intra-abdominal infection. On follow-up which ranged from 1 to 15 months, one patient developed portal vein thrombosis, no upper gastrointestinal rebleeding.Conclusions:Preservation of esophageal veins in laparoscopic selective devascularization is an accurate surgery which requires close teamwork and rich experience in laparoscopic surgery. The preservation of the main trunk of the gastric coronary vein and integrity of the esophageal veins are the keys to the surgery which is safe and feasible.

Objective To explore the safety and feasibility of laparoscopic hepatectomy combined with radiofrequency ablation for primary liver cancer difficult to manage.Methods A retrospective study was conducted to analyze the clinical data of 16 patients who underwent laparoscopic hepatectomy combined with radiofrequency ablation in the Zhejiang Provincial People's Hospital from Apr 2015 to Dec 2017.Results 2 more tumors were found by intraoperative laparoscopic ultrasound.All patients underwent laparoscopic hepatectomy combined with radiofrequency ablation successfully.There were 2 laparoscopic left hepatectomy combined with radiofrequency ablation,2 laparoscopic right hepatectomy combined with radiofrequency ablation,6 laparoscopic left lateral lobectomy combined with radiofrequency ablation,4 laparoscopic right postrior lobectomy combined with radiofrequency ablation and 2 irregular laparoscopic hepatectomy combined with radiofrequency ablation.The intraoperative blood loss ranged from 100-800 ml.The average operative time was (283 ± 112) min.The length of postoperative hospital stay ranged from 5 to 12 days.The tumor-free survival rate after operation is 100％ (16/16) on 6 to 38 months follow up.Conclusion It is safe and feasible to carry out laparoscopic hepatectomy combined with radiofrequency ablation in difficult to manage primary liver cancer.

This paper analyzed the articles from the journal of Chinese Medical Ethics published for 30 years. The results showed that the development of medical ethics in China can be divided into four stages, the incubation period, the slow growth period, the rapid growth period and the stable period;regional distribution was affected by economic development, and the development of medical ethics was also relatively backward in areas where econom-ic development was relatively backward;the number of columns was increasing year by year, the classification tend to be refined, the proportion of each column was fluctuating with the change of the social hotspot, and in recent years, the doctor -patient relationship and medical management and system construction had received more and more attention;and the paper cooperation degree need to be improved, the number of quotations and cited quota-tions steadily improved, and the quality of the paper was improved. Therefore, the government should strengthen policy guidance and standardize the development of medical ethics; the academic level should focus on regional differences and promote academic communication and disciplinary development; and on the individual level, the new medical ethics problem should be concerned, and the research on the hotspots of medical ethics should be car-ried out.

Objective To collect the demographic,lifestyle and clinical factors of patients with cerebrovascular disease,and analyze the vascular cognitive impairment(VCI) factors and set up high-risk factors model.methods 505 patients with cerebrovascular disease hospitalization in department of geriatrics and neurology in hospital from October 2014 to October 2016 were enrolled.According to the questionaire survey data of demographics,lifestyle and clinical factors,the patients were divided into training set (421 cases) and test set (84 cases),and training set were divided into the non-VCI set (225 cases) and VCI set (196 cases).Analyzed the influence factors of VCI in patients with cerebrovascular disease by decision tree algorithm,and compared it with the Logistic regression analysis and chi-square and established the decision tree model for risk factors of VCI.Result sAccording to the VCI decision tree model,cross validation model recognition accuracy was 73.63%,while test set prediction accuracy was 73.81%.Alcoholism,hobbies,education level,tea drinking,diabetes,hypertension,diet,age,sleep and physical exercise were classification of node variables,while drinking was the root.The probability of VCI had significant difference (P<0.05) in the crowds with different risk factors.According to Result s of Logistic regression analysis,education level,drinking,exercise and diabetes were independent risk factors for VCI,while the model prediction accuracy was 66.98%,and test set prediction accuracy was 53.57%.According to the ROC curve of the decision tree model and the Logistic regression model,the decision tree model AUC was 0.737 (95%CI 0.688 to 0.786),and the Logistic regression model AUC was 0.664 (95%CI 0.612 to 0.717).Conclusion It is suggested that the decision tree model might be superior to logistic regression model in the prediction accuracy for VCI of patients with cerebrovascular disease.The alcoholism,diabetes,high blood pressure,high fat diet and insomnia are risk factors of VCI,while hobbies,high level of education,physical exercise and drinking tea can be the protective factors of the VCI.

Objective To evaluate the outcome and safety of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) in the management of esophageal mucosal lesion.Methods The clinical data of 70 patients with esophageal mucosal lesion were analyzed.Twenty-five patients were treated by ESD (ESD group) and 45 patients were treated by EMR (EMR group).The enbloc resection rate,tissue healing resection rate,operation time,complication and recurrence rate were compared between two groups.Results The enbloc resection rate,tissue healing resection rate in ESD group were significantly higher than those in EMR group [60.0％(15/25) vs.48.9％(22/45),48.0％(12/25) vs.40.0％ (18/45)] (P ＜0.05).The local recurrence rate in ESD group was lower than that in EMR group [4.0％ (1/25) vs.20.0％ (9/45)] (P ＜ 0.05).The severe complication such as delayed hemorrhage,perforation,stenosis between two groups had no significant difference (P ＞ 0.05).The operation time in ESD group was (64.3 ±27.1) min,and significantly longer than that in EMR group [(27.6 ± 14.1) min] (P ＜0.05).Conclusions Compare with EMR,ESD has better enbloc resection rate,tissue healing resection rate,and lower recurrence rate.It is more safe and effective in the therapy of esophageal mucosal disease.

Objective To investigate the significance of treadmill exercise test in male patients with coronary heart disease.Methods Two hundred and twenty-four male patients who diagnosed as coronary heart disease by coronary angiography were enrolled in this study,and treadmill exercise test were performed before and 1 month after coronary angiography.The coronary artery stenosis degree and scope were compared between two methods.Results In coronary angiography of 224 patients,the positive was 171 patients and negative was 53 patients.The single stenosis,double stenosis and triple stenosis was 87,55,29 patients.In treadmill exercise test of 224 patients,the positive was 143 patients and negative was 81 patients.The sensibility of treadmill exercise test compared the standard of coronary angiography was 81.3％,positive predictive value was 97.2％.Meanwhile in patients combined with hypertension or diabetic,treadmill exercise test found that the ST segment depression appeared earlier,persistence time longer.The persistence time and the number of down lead in double stenosis and triple stenosis was higher than that in single stenosis.Conclusion Treadmill exercise test is an important method in the diagnosis of coronary artery disease,and can preliminarily estimate the extent of coronary artery stenosis.

Objective To explore the influence of early comprehensive nursing intervention on physical and mental development in children with high risk of cerebral palsy.Methods 150 children with high risk of cerebral palsy who were treated in neonatal intensive care unit(NICU) of Xinxiang central hospital were randomly divided into two groups.78 cases in the intervention group received early comprehensive nursing intervention,including functional training combined with medication and physical treatment method.At the same time,their parents received systematic training and participated in the intervention till the babies reached 2 years old.72 cases in the routine group were given conventional baby care.74 termfor-age neonates who were born in our department of maternity in the same period were selected as the control group,which received conventional baby care.The infants of the routine care group received only conventional baby care.The physical development of the weight,length and head circumference and intelligence of three groups were checked at the age of six months,one year and two years.Results M the age of six months,one and two years old,the physical development were higher significantly in the intervention group than those in the routine group,and had not evident difference with the control group.The mental development index (MDI) of the intervention group was lower than that of the control group at the 6 months,had no obvious difference with the control group at one year old,and was great higher than that of the control group.At the sixth month and one year phychomotor development index (PDI) of the intervention group had no difference with that of the control group,and at two years old were higher than that in the control group.The incidence of the phychomotor development retardment and the cerebral palsy in the intervention group was lower than that in the routine group.Conclusions Early nursing intervention is beneficial to the development of the physical and intelligent development of children with high risk of cerebral palsy.