Objective To investigate the clinical efficacy of the Lower Limb Detumescence Formula(derived from Taohong Siwu Decoction)in treating lower limb swelling in patients with qi stagnation and blood stasis syndrome after total knee arthroplasty(TKA),and to analyze the changes in traditional Chinese medicine(TCM)syndrome types before and after surgery.Methods A total of 60 patients diagnosed with knee osteoarthritis and lower limb swelling with qi stagnation and blood stasis syndrome after TKA,hospitalized in the Department of Artificial Joints and Knee Surgery,The First Affiliated Hospital of Guangzhou University of Chinese Medicine between November 2024 and January 2025,were selected.Based on patients' preferences and postoperative medication,the patients were divided into three groups:the Chinese medicine Group(25 cases),the Lishang Group(15 cases),and the Aescuven Forte Group(20 cases).Changes in limb circumference on the affected side were used to describe knee volume changes,and were measured preoperatively and on postoperative days 1,3,and 30.Results(1)Regarding lower limb swelling,the calf and thigh circumferences of the affected side in all three groups showed a trend of early exacerbation(on postoperative days 1 and 3)followed by later relief(on postoperative day 30).Peak swelling occurred on postoperative day 3,with statistically significant differences compared to preoperative measurements(P＜0.05).Subsequently,swelling gradually alleviated,and the calf and thigh circumferences of the affected side progressively decreased,the circum ferences on postoperative day 30 differed from those on postoperative days 1 and 3(P＜0.05).However,there were no statistically significant differences in improving calf and thigh circumferences among the three groups(P＞0.05).(2)In terms of adverse reactions,the Lishang Group and the Aescuven Forte Group each reported two adverse events,including postoperative wound bleeding,subcutaneous ecchymosis,pulmonary infection,and constipation.The Chinese medicine group reported no gastrointestinal adverse events,and patient treatment compliance was better than that in the Lishang Group and the Aescuven Forte Group.(3)Regarding TCM syndrome differentiation,each patient received four assessments at different time points(preoperatively and on postoperative days 1,3,and 30),resulting in 240 valid data entries.Among these,qi stagnation and blood stasis syndrome was the most common(170 cases,70.83％),followed by liver and kidney deficiency syndrome(64 cases,26.67％),and qi and blood deficiency syndrome was the least common(6 cases,2.50％).(4)Comparison of the relationship between different groups and syndrome types revealed no significant association between group distribution and syndrome type(P＞0.05).Further generalized estimating equation analysis showed that grouping had no significant effect on TCM syndrome differentiation(P＞0.05).(5)Comparison of the relationship between different time points and syndrome types revealed that preoperative syndromes predominantly consisted of liver and kidney deficiency(96.67％),while on postoperative days 1 and 3,all cases were classified as qi stagnation and blood stasis syndrome(100.00％).On postoperative day 30,qi stagnation and blood stasis syndrome remained the most common(80.00％).There was a significant association between time points and syndrome distribution(P＜0.05).Further generalized estimating equation analysis indicated that time points significantly influenced TCM syndrome differentiation(P＜0.001).Conclusion The Lower Limb Detumescence Formula demonstrates efficacy comparable to Lishang Xiaozhong Oral Liquid and Aescuven Forte Tablets in improving lower limb swelling in patients with qi stagnation and blood stasis syndrome after TKA.By promoting blood circulation,resolving stasis,strengthening the spleen,and eliminating accumulation,this formula reduces the incidence of adverse reactions such as postoperative wound bleeding,subcutaneous ecchymosis,and constipation.It provides a new pharmacological option for treating lower limb swelling after TKA,and is particularly suitable for patients with qi stagnation and blood stasis syndrome accompanied by spleen deficiency.

Objective:To assess the current status of geriatrics department development in public general hospitals at or above the second grade in Shandong province.Methods:A cross-sectional survey was conducted from October 27 to November 3, 2023 using a web-based electronic questionnaire to investigate the current status of geriatrics department development in all public general hospitals at or above the second grade across 16 prefecture-level cities in Shandong province.The survey included participation from medical department staff and managers of geriatric medicine departments.Results:Shandong province has 355 public general hospitals at or above the second grade, of which 337 completed the questionnaire.Among these 337 hospitals, 92.28%(311/337)have established geriatric departments, 83.09%(280/337)have set up geriatric clinics, 69.14%(233/337)have independent geriatric wards, and 71.51%(241/337)have implemented comprehensive geriatric assessments(CGA).Regarding the configuration of geriatric departments, 60.24%(203/337)of hospitals met the requirement of having at least 20 ward beds, 34.42%(116/337)met the doctor-to-bed ratio requirement of at least 0.3, and 22.26%(75/337)met the nurse-to-bed ratio requirement of at least 0.6.Only 13 hospitals met all the requirements for geriatric wards, beds, doctors, and nurses, accounting for 3.86%(13/337)of the participating hospitals.Conclusions:The establishment of geriatrics departments in second-grade or higher public general hospitals in Shandong province has surpassed the national target in China ahead of schedule.Most hospitals have established geriatric clinics and wards and have implemented CGA.However, significant challenges remain, including a shortage of ward beds and a lack of medical staff.

Objective:To assess the current status of geriatrics department development in public general hospitals at or above the second grade in Shandong province.Methods:A cross-sectional survey was conducted from October 27 to November 3, 2023 using a web-based electronic questionnaire to investigate the current status of geriatrics department development in all public general hospitals at or above the second grade across 16 prefecture-level cities in Shandong province.The survey included participation from medical department staff and managers of geriatric medicine departments.Results:Shandong province has 355 public general hospitals at or above the second grade, of which 337 completed the questionnaire.Among these 337 hospitals, 92.28%(311/337)have established geriatric departments, 83.09%(280/337)have set up geriatric clinics, 69.14%(233/337)have independent geriatric wards, and 71.51%(241/337)have implemented comprehensive geriatric assessments(CGA).Regarding the configuration of geriatric departments, 60.24%(203/337)of hospitals met the requirement of having at least 20 ward beds, 34.42%(116/337)met the doctor-to-bed ratio requirement of at least 0.3, and 22.26%(75/337)met the nurse-to-bed ratio requirement of at least 0.6.Only 13 hospitals met all the requirements for geriatric wards, beds, doctors, and nurses, accounting for 3.86%(13/337)of the participating hospitals.Conclusions:The establishment of geriatrics departments in second-grade or higher public general hospitals in Shandong province has surpassed the national target in China ahead of schedule.Most hospitals have established geriatric clinics and wards and have implemented CGA.However, significant challenges remain, including a shortage of ward beds and a lack of medical staff.

Objective:To evaluate the long-term efficacy of laparoscopic-assisted natural orifice specimen extraction surgery (NOSES) colectomy using Cai tube for treating left-sided colorectal cancer.Methods:This was a randomized controlled trial. Inclusion criteria were as follows: preoperative pathological diagnosis of left-sided colorectal adenocarcinoma (rectal, sigmoid colon, descending colon, or left transverse colon cancer with the caudad margin ≥8 cm from the anal margin); preoperative abdominal and pelvic computed tomography (or magnetic resonance imaging) showing maximum tumor diameter <4.5 cm; and BMI <30 kg/m 2. Patients with synchronous multiple primary cancers or recurrent cancers, a history of neoadjuvant chemoradiotherapy, preoperative evidence of significant local infiltration, distant metastasis, or complications such as intestinal obstruction and intestinal perforation, or who were not otherwise considered suitable for laparoscopic surgery were excluded. A random number table was used to randomize sequential patients to NOSES surgery using Cai tube (non-assisted incision anal sleeve: patent number ZL201410168748.2) (NOSES group) or traditional laparoscopic-assisted surgery (CLS group). Relevant clinical data of the two groups of patients were analyzed, the main outcomes being disease-free survival, overall survival, overall recurrence rate, and local recurrence rate 5 years after surgery. Results:Patients in both study groups completed the surgery successfully with no requirement for additional surgery. After mean 70 (7–83) months postoperative follow-up, the 5-year overall postoperative survival in the NOSES and CLS groups was 90.0% and 83.3%, respectively ( P=0.455); disease free survival was 90.0% and 83.3%, respectively ( P=0.455); overall recurrence rate 6.6% and 10.0%, respectively ( P=0.625); and local recurrence rate both were 3.3% ( P=0.990), respectively. None of these differences was statistically significant. Conclusions:NOSES and CLS have similar long-term efficacy, and NOSES deserves to be used in clinical practice.

Objective:To evaluate the long-term efficacy of laparoscopic-assisted natural orifice specimen extraction surgery (NOSES) colectomy using Cai tube for treating left-sided colorectal cancer.Methods:This was a randomized controlled trial. Inclusion criteria were as follows: preoperative pathological diagnosis of left-sided colorectal adenocarcinoma (rectal, sigmoid colon, descending colon, or left transverse colon cancer with the caudad margin ≥8 cm from the anal margin); preoperative abdominal and pelvic computed tomography (or magnetic resonance imaging) showing maximum tumor diameter <4.5 cm; and BMI <30 kg/m 2. Patients with synchronous multiple primary cancers or recurrent cancers, a history of neoadjuvant chemoradiotherapy, preoperative evidence of significant local infiltration, distant metastasis, or complications such as intestinal obstruction and intestinal perforation, or who were not otherwise considered suitable for laparoscopic surgery were excluded. A random number table was used to randomize sequential patients to NOSES surgery using Cai tube (non-assisted incision anal sleeve: patent number ZL201410168748.2) (NOSES group) or traditional laparoscopic-assisted surgery (CLS group). Relevant clinical data of the two groups of patients were analyzed, the main outcomes being disease-free survival, overall survival, overall recurrence rate, and local recurrence rate 5 years after surgery. Results:Patients in both study groups completed the surgery successfully with no requirement for additional surgery. After mean 70 (7–83) months postoperative follow-up, the 5-year overall postoperative survival in the NOSES and CLS groups was 90.0% and 83.3%, respectively ( P=0.455); disease free survival was 90.0% and 83.3%, respectively ( P=0.455); overall recurrence rate 6.6% and 10.0%, respectively ( P=0.625); and local recurrence rate both were 3.3% ( P=0.990), respectively. None of these differences was statistically significant. Conclusions:NOSES and CLS have similar long-term efficacy, and NOSES deserves to be used in clinical practice.

BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection. OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection. METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94％ and 86.13％, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection.

Objective To study the protective effect of aminophosphate on peripheral neurotoxicity in patients with gastrointestinal cancer undergoing chemotherapy.Methods Eighty patients receiving mFOLFOX6 regimen chemotherapy in the Eighth Affiliated Hospital of Sun Yat-sen University from June 2015 to February 2018 were selected as the study subjects.They were divided into study group and control group according to random number table method.The control group was given mFOLFOX6 regimen for chemotherapy,while the study group was given intravenous infusion of amphostatin before using mFOLFOX6 regimen for chemotherapy.The occurrence of peripheral neurotoxicity,motor nerve conduction velocity (MSV),sensory nerve conduction velocity (SCV) levels of median nerve and peroneal nerve before and after chemotherapy,short-term efficacy and blood toxicity were compared between the two groups.Results The total incidence of peripheral neurotoxicity was 17.50％ (7/40) in the study group and 82.50％ (33/40) in the control group,and the difference was statistically significant (x2 =33.800;P =0.000).The SCV levels of median nerve and peroneal nerve in the study group after chemotherapy was (53.68±3.02) m/s,(54.96 ±3.01) m/s,and those in the control group were(45.17±3.07) m/s、(44.97±3.03) m/s,and the difference was statistically significant (t =12.498,14.794;P =0.000,0.000).There was no significant difference in the total effective rate (87.50％,35/40) between the study group and the control group(90.00％,36/40) (x2 =0.125;P =0.723).The total incidence of hematotoxicity was 42.50％ (17/40) in the study group and 77.50％ (31/40) in the control group,and the difference was statistically significant(x2 =10.208;P=0.000).Conclusion Amfostine has a better preventive effect on peripheral neurotoxicity incancer patients undergoing chemotherapy,which is conducive to reducing the risk of hematotoxicity.which is worthy of clinical application.

Objective To investigate the clinical features,diagnosis,treatment,and prognosis of patients with liver injury caused by Periploca forrestii Schltr.Methods A retrospective analysis was performed for the general data,clinical manifestations,and laboratory examinations of 22 patients who were diagnosed with liver injury caused by Periploca forrestii Schltr.from November 2014 to December 2015,and their clinical type was determined according to the classification criteria of drug-induced liver injury recommended by the Council for Intemational Organizations of Medical Sciences.Results There were 12 female and 10 male patients.The mean medication time ranged from 1 week to 2 months,and as for biochemical markers,there were mainly abnormalities in alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil),alkaline phosphatase (ALP),and gamma-glutamyl transpeptidase (GGT).ALT and AST increased in all the patients,with mean levels of 676.68±481.11 U/L and 527.36±361.14 U/L,respectively;TBil increased to a mean level of 170.26±147.30 μmol/L in 19 patients;ALP increased to a mean level of 135.61±59.26 U/L in 13 patients;GGT increased to a mean level of 195.65±138.48 U/L in 20 patients.As for clinical typing,18 patients had liver cell injury,none had cholestasis,3 had a mixed type,and 1 had an unclassified type.One patient died and all the other patients fully recovered.Conclusion Periploca forrestii Schltr.had complex constituents,and liver injury caused by this drug is mainly liver cell injury.The pathogenesis of liver injury caused by Periploca forrestii Schltr.is presumed to be related to patients' idiosyncratic reaction to its constituents.

OBJECTIVETo explore the feasibility of laparoscopic-assisted natural orifice specimen extraction radical left colectomy.

METHODSRetrospective analysis was performed on clinicopathological dada of 15 colorectal patients who were treated by laparoscopic-assisted anal specimen extraction radical left colectomy with self-developed surgical instrument Cai tube between January and September in 2014. Tumor location included descending colon (n=3), the junction of descending colon and sigmoid colon (n=2), the sigmoid colon (n=6) and upper rectum (n=4). Clinical efficacy of patients was observed.

RESULTSThere were no perioperative deaths or postoperative complications, such as anastomotic bleeding or leakage. The median operation time was 257 (range 103-337) min, median blood loss was 50(range 20-200) ml, median time to first flatus was 3 (range 1-5) d and median hospital stay was 14 (range 11-21) d. All the patients had good quality of life and normal defecation function without tumor recurrence or metastasis after 1-8 months of follow-up.

CONCLUSIONLaparoscopic-assisted anal specimen extraction radical left colectomy is safe and feasible.

Colectomy ; Colon, Sigmoid ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Postoperative Complications ; Quality of Life ; Rectum ; Retrospective Studies

Objective To explore the feasibility of laparoscopic-assisted natural orifice specimen extraction radical left colectomy. Methods Retrospective analysis was performed on clinicopathological dada of 15 colorectal patients who were treated by laparoscopic-assisted anal specimen extraction radical left colectomy with self-developed surgical instrument Cai tube between January and September in 2014. Tumor location included descending colon (n=3), the junction of descending colon and sigmoid colon (n=2), the sigmoid colon (n=6) and upper rectum (n=4). Clinical efficacy of patients was observed. Results There were no perioperative deaths or postoperative complications , such as anastomotic bleeding or leakage. The median operation time was 257 (range 103-337) min, median blood loss was 50(range 20-200) ml, median time to first flatus was 3(range 1-5) d and median hospital stay was 14 (range 11-21) d. All the patients had good quality of life and normal defecation function without tumor recurrence or metastasis after 1-8 months of follow-up. Conclusion Laparoscopic-assisted anal specimen extraction radical left colectomy is safe and feasible.