【Objective】To determine the effects of an open-lung strategy（OLS）comprising moderate positive end- expiratory pressure （PEEP） and intermittent recruitment manoeuvres（RMs） on plasma levels of lung epithelial injury markers［i.e. soluble receptor for advanced glycation end products（sRAGE）and Clara cell protein（CC16）］during low- tidal-volume ventilation for surgery.【Methods】One hundred patients who were undergoing laparoscopic colorectal cancer resection under low-tidal-volume ventilation were enrolled in this study. They were randomly assigned（1∶1）to the OLS group（using PEEP of 6~8 cmH2O and intermittent RM），or the NOLS group（without using PEEP and RM）. Blood samples were taken before anesthesia induction（T1），immediately after surgery（T2）and the postoperative day 3（T3）to measure the plasma concentrations of sRAGE and CC16. 【Results】 Significant differences were not observed in the concentrations of sRAGE and CC16 at T1，T2 and T3 between the two groups（all P > 0.05）. For all the enrolled patients， the concentrations of sRAGE at T2 and T3 were higher than that at T1，the concentration of sRAGE at T3 was higher than that at T2，and the concentration of CC16 at T3 was higher than that at T1 and T2（all P < 0.05）.【Conclusions】In patients under general anesthesia with low-tidal-volume ventilation，the using of an OLS comprising medium PEEP and intermittent RMs can not alter plasma levels of lung epithelial injury markers（sRAGE and CC16）in three days after surgery.

Diemailing~® Kudiezi Injection( DKI) is widely used in the treatment of cerebral infarction,coronary heart disease and angina pectoris. Long-term clinical application and related research evidence showed that DKI has a good effect in improving the clinical symptoms of cardiovascular and cerebrovascular diseases. However,this injection has not been included in any clinical practice guideline. It has been found that the use of DKI is in wrong way in clinical practice in recent years. Therefore,clinical experts from the field of cardiovascular and cerebrovascular diseases nationwide are invited to compile this expert consensus in order to guide clinicians.GRADE system is used to grade the quality of evidence according to different outcomes according to degrading factors. Then it forms the recommendation or consensus suggestion through the nominal group method. The formation of expert consensus mainly considers six factors: quality of evidence,economy,efficacy,adverse reactions,patient acceptability and others. Based on these six aspects,if the evidence is sufficient,a " recommendation" supported by evidence is formed,and GRADE grid voting rule is adopted. If the evidence is insufficient,a " consensus suggestions" will be formed,using the majority voting rule. In this consensus,the clinical indications,efficacy,safety evidences and related preliminary data of DKI were systematically and comprehensively summarized in a concise and clear format,which could provide valuable reference for the clinical use of DKI. This consensus has been approved by China association of Chinese medicine which is numbered GS/CACM 202-2019.
Angina Pectoris ; drug therapy ; Cerebral Infarction ; drug therapy ; China ; Consensus ; Coronary Disease ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Injections ; Medicine, Chinese Traditional

For the researches relating to the biomedical fields such as preparation of drug micro-particulates and biomedical materials coating, according to the modular design concept and combing the piezoelectric micro-jetting technology with electromechanical engineering and automatic control technology, the drug micro-jetting multifunctional system was designed, which included the spraying support subsystem, - motion platform, -axis subsystem and rapid installation subsystem. The drug micro-jetting multifunctional system was run and adjusted. The versatility, rationality and feasibility of this system were validated by the experiments of amoxicillin microcapsule preparation, titanium alloy drug-loaded coating preparation and balloon electrode coating preparation. It was shown that the system can be used as basic platform in multi-disciplinary cross technology research such as biomedical engineering, pharmaceutical engineering and so on.
Alloys ; Drug Delivery Systems ; Electrodes ; Titanium

Objective: To explore the safety and feasibility of colonoscopy - assisted transanal minimally invasive surgery via glove port (CA-TAMIS-GP) in the treatment of early rectal tumors. Methods: A total of 67 patients evaluated as early rectal tumors (adenoma limited within mucosal layer) with diameter ≤4.0 cm at Department of Anal-Colorectal Surgery, Hangzhou Third People′s Hospital from July 2013 to March 2017 were prospectively enrolled in the study. Benign tumors were diagnosed by preoperative imaging in all the patients with the distance to anal edge of 4 to 20 cm. Patients were randomly divided into treatment group and the control group according to the random number table. The treatment group (n=32) underwent CA-TAMIS-GP, including 19 males and 13 females with mean age of (55.6±11.2) years and mean tumor size of (3.3±0.4) cm, while the control group (n=35) underwent endoscopic submucosal dissection (ESD, control group), including 20 males and 15 females with mean age of (52.9±12.3) years and mean tumor size of (3.4±0.5) cm. Differences of baseline data between two groups were not significant (all P>0.05). The specific method of CA-TAMIS-GP was as follows: a surgical rubber glove sleeve (No.6) was passed through the anal device; the glove was fixed at the anvil device; after fully expanding the anus, the anal sac was placed into the anus with the fingers outside; then, the cuff and the anal sac were sutured and fixed to the perianal; a well-tight glove path was established; the ultrasonic scalpel, grasper and the colonoscopy lens connected to the host platform and the electric negative pressure suction were inserted into the three finger sleeves respectively and fixed by rubber band or silk thread; the laparoscopic instruments such as the grasper and the ultrasonic scalpel were used for pulling, grasping, cutting, electrocoagulation, suturing and other operations to complete the resection of rectal lesions. Efficacy, postoperative complication and operative cost, etc. between two groups were compared using the student′s t test, chi-square tests, and Fisher′s exact test. Results: Operations of two groups were completed successfully without conversion to laparotomy. Histopathologic examination showed all specimens had negative margins with the surgical resection of the layer to the submucosa, and showed no significant differences between two groups (P>0.05). Compared to the control group, the operation time was shorter [(49.5±14.6) minutes vs.(66.1±17.6) minutes, t=-4.235, P<0.001], and the intraoperative hemorrhage was less [(4.2±1.6) ml vs. (6.2±2.1) ml, t=-4.349, P<0.001] in the treatment group with significant differences. In the treatment group, 6 patients had mild anal pain or discomfort after operation, and 1 patient in the control group showed anal foreign body sensation. The difference was statistically significant [18.8% (6/32) vs. 2.9% (1/35), P=0.048]. The incidence of postoperative hematochezia in the treatment group was lower than that in the control group [9.4% (3/32) vs. 20.0% (7/35), P=0.310] without significant difference. The cost of consumables in the treatment group was (1586.9±204.4) yuan, which was lower than (7694.4±1123.2) yuan in control group, and the difference was statistically significant (t=-30.880, P<0.001). All the patients were followed up for 6 to 36 months after operation, and no recurrence or long-term complication occurred in the treatment group, while 1 case developed local recurrence in the control group. Conclusion CA-TAMIS-GP is a safe and effective method for early rectal tumors with simple and economical characteristics, which broadens the application of colonoscopy.

Objective To explore the safety and feasibility of colonoscopy?assisted transanal minimally invasive surgery via glove port (CA?TAMIS?GP) in the treatment of early rectal tumors. Methods A total of 67 patients evaluated as early rectal tumors (adenoma limited within mucosal layer) with diameter≤4.0 cm at Department of Anal?Colorectal Surgery, Hangzhou Third People′s Hospital from July 2013 to March 2017 were prospectively enrolled in the study. Benign tumors were diagnosed by preoperative imaging in all the patients with the distance to anal edge of 4 to 20 cm. Patients were randomly divided into treatment group and the control group according to the random number table. The treatment group (n=32) underwent CA?TAMIS?GP, including 19 males and 13 females with mean age of (55.6±11.2) years and mean tumor size of (3.3 ± 0.4) cm, while the control group (n=35) underwent endoscopic submucosal dissection (ESD, control group), including 20 males and 15 females with mean age of (52.9± 12.3) years and mean tumor size of (3.4±0.5) cm. Differences of baseline data between two groups were not significant (all P>0.05). The specific method of CA?TAMIS?GP was as follows: a surgical rubber glove sleeve (No. 6) was passed through the anal device; the glove was fixed at the anvil device; after fully expanding the anus, the anal sac was placed into the anus with the fingers outside; then, the cuff and the anal sac were sutured and fixed to the perianal; a well?tight glove path was established; the ultrasonic scalpel, grasper and the colonoscopy lens connected to the host platform and the electric negative pressure suction were inserted into the three finger sleeves respectively and fixed by rubber band or silk thread; the laparoscopic instruments such as the grasper and the ultrasonic scalpel were used for pulling, grasping, cutting, electrocoagulation, suturing and other operations to complete the resection of rectal lesions. Efficacy, postoperative complication and operative cost, etc. between two groups were compared using the student′s t test, chi?square tests, and Fisher′s exact test. Results Operations of two groups were completed successfully without conversion to laparotomy. Histopathologic examination showed all specimens had negative margins with the surgical resection of the layer to the submucosa, and showed no significant differences between two groups (P>0.05). Compared to the control group, the operation time was shorter [(49.5 ± 14.6) minutes vs. (66.1 ± 17.6) minutes, t=-4.235, P<0.001], and the intraoperative hemorrhage was less [(4.2 ± 1.6) ml vs. (6.2 ± 2.1) ml, t=-4.349, P<0.001] in the treatment group with significant differences. In the treatment group, 6 patients had mild anal pain or discomfort after operation, and 1 patient in the control group showed anal foreign body sensation. The difference was statistically significant [18.8% (6/32) vs. 2.9% (1/35), P=0.048]. The incidence of postoperative hematochezia in the treatment group was lower than that in the control group [9.4% (3/32) vs. 20.0% (7/35), P=0.310] without significant difference. The cost of consumables in the treatment group was (1586.9±204.4) yuan, which was lower than (7694.4±1123.2) yuan in control group, and the difference was statistically significant (t=-30.880, P<0.001). All the patients were followed up for 6 to 36 months after operation, and no recurrence or long?term complication occurred in the treatment group, while 1 case developed local recurrence in the control group. Conclusion CA?TAMIS?GP is a safe and effective method for early rectal tumors with simple and economical characteristics, which broadens the application of colonoscopy.