Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Objective:To explore the application effect of " visual nursing map" in coronary artery bypass grafting (CABG).Methods:A retrospective analysis was made on 76 patients who underwent CABG in Beijing Friendship Hospital, Capital Medical University from June 2021 to June 2023. 38 cases admitted from June 2021 to May 2022 were included in the control group, and 38 cases admitted from June 2022 to June 2023 were included in the observation group. The control group was given intraoperative routine nursing, and the observation group was given "visual nursing map" nursing measures on this basis. The preoperative preparation time and intraoperative pause time between the two groups were observed and compared. The measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for inter-group comparison. Counting data were expressed as cases and percentages, and Chi-square test was used for inter-group comparison. Results:In the control group, the preoperative preparation time was (93.2±8.5) min, and the longest procedure was the placement of electrosurgical equipment and instrument trolley, which were (6.4±0.8) min and (32.6±3.5) min, respectively. The intraoperative pause time was (7.3±0.7) min, and the longest time was the unskilled nursing cooperation of proximal and distal vascular anastomosis and the incomplete preparation of sterile surgical materials, which were (2.2±0.4) min and (1.4±0.3) min, respectively. In the observation group, the preoperative preparation time and intraoperative pause time were significantly reduced compared with the control group after the use of "visual nursing map" management on the basis of the control group, which were (79.4±5.4) and (93.2±8.5) min, (4.4±0.6) and (7.3±0.7) min, respectively, and the differences were statistically significant ( P<0.05). Conclusion:The application of "visual nursing graph" in CABG can effectively reduce the preoperative preparation time and intraoperative pause time, and should be further promoted.

Objective:To compare the differences in chemical compositions before and after processing by different processing methods; To optimize the processing method of Atractylodes lancea Rhizoma.Methods:Atractylodes lancea Rhizoma was processed by stir-frying with bran and treating with rice washing water. The volatile and non-volatile components of raw Atractylodes lancea Rhizoma, bran-fried Atractylodes lancea Rhizoma and rice washing water treated Atractylodes lancea Rhizome were qualitatively analyzed by headspace gas chromatography-mass spectrometry (HS-GC-MS) and ultra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high-resolution mass spectrometry (UPLC-Q-Orbitrap HRMS), and the differences in chemical composition before and after processing were compared.Results:The volatile components of the three different products were determined to have 18 common components, such as agarospirol, β-eudesol, etc. In addition, 86 non-volatile components were determined. The peak area response value of atractylodin, the index component prescribed by pharmacopoeia, decreased after processing, but there was little difference in bran stir-frying and rice-washed water frying.Conclusions:Different processing methods have certain effects on the chemical composition of Atractylodes lancea Rhizoma. Among them, the bran-frying method is superior in improving the quality of preparations, reducing production costs and improving production efficiency. The bran-fried product can be used as raw material for preparation production.

Objective To investigate the reparative effect of astragaloside IV on hypoxia-reoxygenation-induced cardiomyocyte injury by regulating the thioredoxin-interacting protein(TXNIP)-Nod-like receptor protein 3(NLRP3)pathway.Methods H9c2 cardiomyocytes were divided into control group,hypoxia-reoxygenation group,astragaloside IV low-and high-dose groups,astragaloside IV high-dose+pcDNA-NC group,and astragaloside IV high-dose+pcDNA-TXNIP group.After intervention,H9c2 proliferation was measured by Cell Counting Kit 8(CCK-8)assay,apoptosis was detected by flow cytometry,lactate dehydrogenase(LDH)and superoxide dismutase(SOD)activities were determined by WST-8 assay,probebyreactive oxygen species(ROS)generation was measured by 2',7'-dichlorodihydrofluorescein diacetate(DCFDA)fluorescent,enzyme-linked inmunosorbent assay(ELISA)was used to quantify interleukin 6(IL-6)and tumor necrosis factor α(TNF-α)levels,Western Blot was used to analyze the protein expression of TXNIP and NLRP3.Results Compared with the control group,the hypoxia-reoxygenation group showed significantly decreased cell survival rate and SOD activity(P＜0.05),with increased apoptosis rate,LDH level,ROS generation,IL-6 and TNF-α levels,and protein expression levels of TXNIP and NLRP3(P＜0.05).Compared with the hypoxia-reoxygenation group,the cell survival rate and SOD activity in the low-dose and high-dose astragaloside IV groups were significantly increased(P＜0.05),and the apoptosis rate,LDH level,ROS production,IL-6 and TNF-α levels and protein expression levels of TXNIP and NLRP3 were significantly decreased(P＜0.05).Compared with the high-dose astragaloside IV+pcDNA-NC group,the cell survival rate and SOD activity in the high-dose astragaloside IV+pcDNA-TXNIP group were significantly decreased(P＜0.05),and the apoptosis rate,LDH level,ROS production,IL-6 and TNF-α levels and protein expression levels of TXNIP and NLRP3 were significantly increased(P＜0.05).Conclusion Astragaloside IV may alleviate hypoxia-reoxygenation-induced cardiomyocyte damage by downregulating key proteins in the TXNIP-NLRP3 pathway.

TCM dispensing is the most basic clinical pharmaceutical work of TCM.In recent years,based on the 9 key technologies of TCM dispensing,the TCM dispensing industry has ushered in great development,and innovative TCM dispensing information system and intelligent dispensing equipment have appeared.This article sorted out the current situation of TCM dispensing industry and looked forward to its future development route.The results showed that the introduction of new technology and new equipment in the key technical links of procurement acceptance,dispensing review,TCM decocting,medication guidance and so on have improved the quality of dispensing service and ensured the quality and safety of medication.In the development of modern TCM dispensing industry,it is necessary to improve the quality control standard system,service standard system and core equipment standard system in the standardization of dispensing technology;in terms of talent cultivation in the field of dispensing,it is necessary to focus on restructuring and building new educational models to cultivate new medical talents that intersect medical and engineering fields;in terms of informatization and intelligence,it is necessary to develop intelligent equipment that is more in line with the characteristics of TCM,and further promote and improve the"shared TCM pharmacy"model.Through improving the content of TCM clinical pharmaceutical care,developing new technology and equipment of TCM dispensing,and improving the level of dispensing service and education,it is expected to gradually realize the standardization,informatization and intelligent development of modern TCM dispensing industry.

Objective To retrospectively analyse the use of TCM injections in Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University from 2019 to 2023;To evaluate the reasonableness of its clinical use of medication;To provide theoretical guidance for clinical work in the new situation.Methods Relevant data on the use of TCM injections in a hospital from 2019 to 2023 were collected,and the research method of retrospective analysis was used to analyse their use and medication law.Results From 2019 to 2023,the overall amount of use of TCM injections and the ratio of the amount of use of Western patent medicines showed a downward trend year by year;the amount of anti-neoplastic drugs TCM injections ranked in the first place although it decreased year by year,and the amount of use of enucleating agents and oncological auxiliary drugs TCM injections showed a downward trend;the changes in the consumption of TCM injections,the defined daily doses,and the defined daily cost fluctuated greatly,which was relevant to the medical insurance policy and the inclusion of the nationally negotiated medicines;both the infection of COVID-19 and medical policy played a great influence on the application of TCM injections.Conclusion The use of TCM injections is subject to changes in policy and the influence of social environment,and the supervision of the use of TCM injections should be strengthened to ensure the rational use of medication and medication safety for patients.

Objective To analyze the use of Chinese patent medicines containing toxic TCM decoction pieces in Beijing Hospital of Traditional Chinese Medicine of Capital Medical University(hereinafter referred to as"our hospital")from 2021 to 2023;To provide references for reasonable management of Chinese patent medicines containing toxic TCM decoction pieces in medical institutions.Methods The Chinese patent medicines containing toxic TCM decoction pieces from 2021 to 2023 were collected in our hospital.Statistics on the number of varieties,efficacy and sales amount of Chinese patent medicines containing toxic TCM decoction pieces were performed.Results From 2021 to 2023,there were 110 kinds of Chinese patent medicines containing toxic TCM decoction pieces and 10 kinds of Chinese patent medicines containing TCM decoction pieces with heavy toxicity,among which the ones of promoting blood circulation and removing blood stasis ranked first.The top 3 TCM decoction pieces with heavy toxicity were raw Aconiti Kusnezoffii Radix,raw Aconiti Radix,Strychni Semen;the top 5 TCM decoction pieces with toxicity were Cinnabaris,Realgar,processed Aconiti Kusnezoffii Radix,Aconiti Lateralis Radix Praeparata,Scorpio;the top 3 TCM decoction pieces with light toxicity were Armeniacae Semen Amarum,Hirudo,Eupolyphaga Steleophaga.The top 15 Chinese patent medicines containing toxic TCM decoction pieces in our hospital was relatively stable,especially the Guanjie Kebi Pills in the first place.Conclusion Based on the analysis of the use of Chinese patent medicines containing toxic TCM decoction pieces from 2021 to 2023,this article discuss measures to ensure the safe use of Chinese patent medicines containing toxic TCM decoction pieces,with certain feasibility and necessity.

Objective:To summarise the effect of free perforator flap of radial collateral artery on reconstruction of first web contracture after hand injury.Methods:Retrospective analysis was conducted based on the clinical data of patients with first web contracture after hand injury in the Department of Hand and Foot Surgery and Rehabilitation, Guangdong Work Injury Rehabilitation Hospital from November 2019 to June 2022. Ten patients, 8 males and 2 females aged between 27 and 51 years old with an average of 40.5 years old were included. There were 6 left hands and 4 right hands. Width and the included angle of first web were measured before surgery. Four hands were classified as severe first web contracture, and the rest of 6 hands had moderate first web contracture. After release scars of the first web, the areas of wound were 5.5 cm × 2.0 cm - 10.5 cm × 3.0 cm. The flaps sized were 6.0 cm×2.5 cm - 11.0 cm × 3.5 cm. All of flaps carried the posterior cutaneous nerve of forearm. Donor sites were closed directly. All patients were included in postoperative follow-up regularly through outpatient clinic or via WeChat reviews. The colour, texture, process in change of the transferred flaps, donor and recipient sites healing and complications were observed.Results:All 10 flaps survived and the wound healed by first intention. The patients received 7 to 15 months (10.5 months in average) of postoperative follow-up. The flaps were not bulky, texture and colour were satisfactory and without pigmentation. Protective sensations restored in 6 patients. At the last follow-up, average included angle of the first webs was 47.14°±1.68°, in comparison with 35.43°±3.60° before surgery. The average width of first webs was 5.34 cm±0.52 cm, in comparison with 3.17 cm±0.75 cm before surgery, the differences were statistically significant ( P<0.01). Eight hands were rated excellent, and 2 were good. There were only linear scars left at the donor sites, without sign of radial nerve injury. Conclusion:The free perforator flap of radial collateral artery is a safe and effective method for repair of first web contracture after hand injury.

Humans ; Clavicle ; Fractures, Bone/surgery*

Objective:To investigate the influences of age-adjusted Charlson comorbidity index (ACCI) on prognosis of patients undergoing laparoscopic radical gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 242 gastric cancer patients who underwent laparoscopic radical gastrectomy in 19 hospitals of the Chinese Laparoscopic Gastrointestinal Surgery Study Group-04 study, including 54 patients in Fujian Medical University Union Hospital, 32 patients in the First Hospital of Putian City, 32 patients in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 31 patients in Zhangzhou Affiliated Hospital of Fujian Medical University, 17 patients in Nanfang Hospital of Southern Medical University, 11 patients in the First Affiliated Hospital with Nanjing Medical University, 8 patients in Qinghai University Affiliated Hospital, 8 patients in Meizhou People′s Hospital, 7 patients in Fujian Provincial Hospital, 6 patients in Zhongshan Hospital of Fudan University, 6 patients in Longyan First Hospital, 5 patients in the First Affiliated Hospital of Xinjiang Medical University, 5 patients in the First Hospital Affiliated to Army Medical University, 4 patients in the Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, 4 patients in West China Hospital of Sichuan University, 4 patients in Beijing University Cancer Hospital, 3 patients in the First Affiliated Hospital of Xiamen University, 3 patients in Guangdong Provincial People′s Hospital, 2 patients in the First Affiliated Hospital of Xi′an Jiaotong University, from September 2016 to October 2017 were collected. There were 193 males and 49 females, aged 62(range, 23?74)years. Observation indicators: (1) age distribution, comorbidities and ACCI status of patients; (2) the grouping of ACCI and comparison of clinicopathological characteristics of patients in each group; (3) incidence of postoperative early complications and analysis of factors affecting postoperative early complications; (4) follow-up; (5) analysis of factors affecting the 3-year recurrence-free survival rate of patients. Follow-up was conducted using outpatient examination or telephone interview to detect postoperative survival of patients up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the nonparametric rank sum test. The X-Tile software (version 3.6.1) was used to analyze the best ACCI grouping threshold. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-Rank test was used for survival analysis. The Logistic regression model was used to analyze the factors affecting postoperative early complications. The COX proportional hazard model was used for univariate and multivariate analyses of factors affecting the 3-year recurrence-free survival rate of patients. Multivariate analysis used stepwise regression to include variables with P<0.05 in univariate analysis and variables clinically closely related to prognosis. Results:(1) Age distribution, comor-bidities and ACCI status of patients. Of the 242 patients, there were 28 cases with age <50 years, 68 cases with age of 50 to 59 years, 113 cases with age of 60 to 69 years, 33 cases with age of 70 to 79 years. There was 1 patient combined with mild liver disease, 1 patient combined with diabetes of end-organ damage, 2 patients combined with peripheral vascular diseases, 2 patients combined with peptic ulcer, 6 patients combined with congestive heart failure, 8 patients combined with chronic pulmonary diseases, 9 patients with diabetes without end-organ damage. The ACCI of 242 patients was 2 (range, 0-4). (2) The grouping of ACCI and comparison of clinicopathological characteristics of patients in each group. Results of X-Tile software analysis showed that ACCI=3 was the best grouping threshold. Of the 242 patients, 194 cases with ACCI <3 were set as the low ACCI group and 48 cases with ACCI ≥3 were set as the high ACCI group, respectively. Age, body mass index, cases with preoperative comorbidities, cases of American Society of Anesthesiologists classification as stage Ⅰ, stage Ⅱ, stage Ⅲ, tumor diameter, cases with tumor histological type as signet ring cell or poorly differentiated adenocarcinoma and cases with tumor type as moderately or well differentiated adenocarcinoma, cases with tumor pathological T staging as stage T1, stage T2, stage T3, stage T4, chemotherapy cycles were (58±9)years, (22.6±2.9)kg/m 2, 31, 106, 85, 3, (4.0±1.9)cm, 104, 90, 16, 29, 72, 77, 6(4,6) in the low ACCI group, versus (70±4) years, (21.7±2.7)kg/m 2, 23, 14, 33, 1, (5.4±3.1)cm, 36, 12, 3, 4, 13, 28, 4(2,5) in the high ACCI group, showing significant differences in the above indicators between the two groups ( t=-14.37, 1.98, χ2=22.64, Z=-3.11, t=-2.91, χ2=7.22, Z=-2.21, -3.61, P<0.05). (3) Incidence of postoperative early complications and analysis of factors affecting postoperative early complications. Of the 242 patients, 33 cases had postoperative early complications, including 20 cases with local complications and 16 cases with systemic complica-tions. Some patients had multiple complications at the same time. Of the 20 patients with local complications, 12 cases had abdominal infection, 7 cases had anastomotic leakage, 2 cases had incision infection, 2 cases had abdominal hemorrhage, 2 cases had anastomotic hemorrhage and 1 case had lymphatic leakage. Of the 16 patients with systemic complications, 11 cases had pulmonary infection, 2 cases had arrhythmias, 2 cases had sepsis, 1 case had liver failure, 1 case had renal failure, 1 case had pulmonary embolism, 1 case had deep vein thrombosis, 1 case had urinary infection and 1 case had urine retention. Of the 33 cases with postoperative early complications, there were 3 cases with grade Ⅰ complications, 22 cases with grade Ⅱ complications, 5 cases with grade Ⅲa complications, 2 cases with grade Ⅲb complications and 1 case with grade Ⅳ complica-tions of Clavien-Dindo classification. Cases with postoperative early complications, cases with local complications, cases with systemic complications were 22, 13, 9 in the low ACCI group, versus 11, 7, 7 in the high ACCI group, respectively. There were significant differences in cases with postoperative early complications and cases with systemic complications between the two groups ( χ2=4.38, 4.66, P<0.05), and there was no significant difference in cases with local complications between the two groups ( χ2=2.20, P>0.05). Results of Logistic regression analysis showed that ACCI was a related factor for postoperative early complications of gastric cancer patients undergoing laparoscopic radical gastrectomy [ odds ratio=2.32, 95% confidence interval ( CI) as 1.04-5.21, P<0.05]. (4) Follow-up. All the 242 patients were followed up for 36(range,1?46)months. During the follow-up, 53 patients died and 13 patients survived with tumor. The 3-year recurrence-free survival rate of the 242 patients was 73.5%. The follow-up time, cases died and cases survived with tumor during follow-up, the 3-year recurrence-free survival rate were 36(range, 2-46)months, 29, 10, 80.0% for the low ACCI group, versus 35(range, 1-42)months, 24, 3, 47.4% for the high ACCI group. There was a significant difference in the 3-year recurrence-free survival rate between the two groups ( χ2=30.49, P<0.05). (5) Analysis of factors affecting the 3-year recurrence-free survival rate of patients. Results of univariate analysis showed that preoperative comorbidities, ACCI, tumor diameter, histological type, vascular invasion, lymphatic invasion, neural invasion, tumor pathological TNM staging, postoperative early complications were related factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy [ hazard ratio ( HR)=2.52, 3.64, 2.62, 0.47, 2.87, 1.90, 1.86, 21.77, 1.97, 95% CI as 1.52-4.17, 2.22-5.95, 1.54-4.46, 0.27-0.80, 1.76-4.70, 1.15-3.12, 1.10-3.14, 3.01-157.52, 1.11-3.50, P<0.05]. Results of multivariate analysis showed that ACCI, tumor pathological TNM staging, adjuvant chemotherapy were indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy ( HR=3.65, 11.00, 40.66, 0.39, 95% CI as 2.21-6.02, 1.40-86.73, 5.41-305.69, 0.22-0.68, P<0.05). Conclusions:ACCI is a related factor for post-operative early complications of gastric cancer patients undergoing laparos-copic radical gastrectomy. ACCI, tumor pathological TNM staging, adjuvant chemotherapy are indepen-dent influencing factors for postoperative 3-year recurrence-free survival rate of gastric cancer patients undergoing laparoscopic radical gastrectomy.