Objective To explore the effects of enhanced recovery after surgery (ERAS) on postoperative recovery, psychological state and complications of patients with laparoscopic gastrointestinal surgery. Methods Ninety-eight patients with laparoscopic gastrointestinal surgery admitted to Huzhou Central Hospital from January 2016 to December 2017 were enrolled and they were divided into two groups (49 cases in each group) according to difference in nursing. During peri-operative period, the routine nursing group was given routine nursing; while the ERAS nursing group received the nursing of ERAS. The postoperative recovery, inflammatory response and nutritional status, complications, psychological state and nursing satisfaction were compared between the two groups. Results Compared with the routine nursing group, the gastrointestinal tract exhaust time, common food intake time, incision healing time, ambulation time and hospital stay were significantly shorter in ERAS nursing group [gastrointestinal tract exhaust time (days): 2.43±1.02 vs. 3.46±1.15, common food intake time (days): 4.24±1.36 vs. 6.23±1.52, incision healing time (days): 7.62±1.54 vs. 9.63±1.63, ambulation time (days): 8.80±2.32 vs. 11.24±2.02, hospital stay (days):10.23±2.12 vs.14.56±2.37, all P < 0.05]. After operation, the high-sensitivity C-reactive protein (hs-CRP) in the two groups was increased first and then decreased, and the levels of transferrin (TRF) and prealbumin (PA) were decreased first and then increased, and the differences were statistically significant at different time points within-groups (P < 0.05), and the changes of indexes in the 5 days after operation in the ERAS nursing group were more significant than those in the routine nursing group [hs-CRP (mg/L): 27.4±6.2 vs. 35.6±9.1, TRF (g/L): 1.89±0.05 vs. 1.81±0.06, PA (mg/L):340±20 vs. 280±20, all P < 0.05]. The postoperative incidences of nausea and vomiting and sore throat in ERAS nursing group were significantly lower than those in routine nursing group [nausea and vomiting: 32.65% (16/49) vs. 67.35% (33/49), sore throat: 12.24% (6/49) vs. 51.02% (25/49), both P < 0.05], and there were no significant differences in postoperative incidences of abdominal distension, incision infection, pulmonary infection and anastomotic leakage between the two groups [abdominal distension: 4.08% (2/49) vs. 6.12% (3/49), incision infection: 4.08% (2/49) vs. 6.12% (3/49), pulmonary infection: 2.04% (1/49) vs. 6.12% (3/49), anastomotic leakage: 2.04% (1/49) vs. 4.08% (2/49), all P >0.05]. The scores of self-rating anxiety scale (SAS) at discharge in the two groups were lower than those before operation, and the degree of decrease in ERAS nursing group was greater than that in routine nursing group (39.21±4.64 vs. 46.56±4.53, P < 0.05). The nursing satisfaction rate in ERAS nursing group was significantly higher than that in routine nursing group [95.92% (47/49) vs. 77.55% (38/49), P < 0.05]. Conclusion ERAS for laparoscopic gastrointestinal surgery not only can promote the recovery of gastrointestinal function, improve the nutritional status and reduce inflammatory response and postoperative complications, but also can relieve anxiety, shorten hospital stay and elevate nursing satisfaction, therefore it is worthy to promote and apply in clinical nursing.

Objective: To investigate the regularity and clinical significance of abnormal bone uptake of ⁹⁹Tc^m-methylene bisphosphonate (MDP) in benign and malignant lesions. Methods: A retrospective analysis was performed on 266 patients (132 males, 134 females, age range: 8-85 years) with abnormal uptake of ⁹⁹Tc^m-MDP in extraosseous tissues from September 2015 to March 2018. The final diagnosis of abnormal uptake was made according to the histopathology, laboratory and related imaging examination (CT, MRI, ultrasound, SPECT/CT or PET/CT imaging) results within 2 weeks after ⁹⁹Tc^m-MDP imaging. Regularity of abnormal ⁹⁹Tc^m-MDP uptake was comprehensively analyzed. Differences between benign and malignant groups were compared by χ² test or Fisher exact test. Results: Abnormal ⁹⁹Tc^m-MDP uptake in extraosseous tissues in 232 patients (87.2%, 232/266) were confirmed as malignant lesions and those in 34 patients (12.8%, 34/266) were benign. There were no significant differences in gender (χ²=0.611, P>0.05), age (P=0.584), and location (P=0.118) between benign and malignant lesions, but the involvement was significantly different (χ²=19.515, P<0.05). There were significant differences between single focus and diffuse foci of single organ, diffuse foci of single organ and multiple foci groups (χ²=8.959, 19.325, both P<0.01). Conclusions The detection rate of malignancy among foci with abnormal ⁹⁹Tc^m-MDP uptake in extraosseous tissues is high, and the malignancy may relate with the involvement of foci. When extraosseous uptake is found, clinical information and related examination results should be comprehensively analyzed and the malignancy should be taken into account.

Objective: To evaluate the clinical efficacy of hematoporphyrin monomethyl ether-based photodynamic (HMME-PDT) therapy for the treatment of port-wine stain (PWS) and its sonographic changes. Methods: A total of 45 patients with confirmed PWS were enrolled from the Department of Dermatology, Third Affiliated Hospital of Soochow University from March 2017 to June 2018, including 5 with pink PWS, 39 with purplish red PWS and 1 with thickened PWS. All the patients received 3 sessions of HMME-PDT therapy. The skin thickness and density were compared before and after the treatment by using high-frequency ultrasound. Ranked data were analyzed by using nonparametric test. Measurement data were expressed as mean ± standard deviation, and analyzed using ony-way analysis of variance. Multiple comparisons were performed using Student-Newman-Keuls-q (SNK-q) test. The results were considered to be statistically significant if P < 0.05. Results: Among the 45 patients with PWS who completed the treatment and follow-up, 10 were cured, 21 received marked improvement, 12 received improvement, and 1 showed no response. The total response rate was 97.78%, and the response rate in the patients with pink PWS was higher than that in the patients with purplish red PWS (U = 12.50, P < 0.001) . The difference value of the skin thickness or skin density before and after the treatment significantly differed among the cured patients, patients receiving marked improvement and those receiving improvement (skin thickness:0.65 ± 0.21, 0.56 ± 0.88, 0.37 ± 0.12 mm respectively; skin density: -8.65 ± 2.19, -6.86 ± 2.79, -4.92 ± 2.91 g/cm³ respectively; F = 14.528, 5.428 respectively, both P < 0.001) , and the difference values of the skin thickness and density were significantly higher in the cured patients than in those receiving improvement (q = 5.82, 4.63, both P < 0.05) . Erythematous swelling to different extents occurred at the laser-exposed sites in the zygomatic and cheek region in 23 patients with PWS and in the frontal-zygomatic region in 6 with PWS after the HMME-PDT therapy, but gradually regressed about 1 week later. Pale brown crusts were observed at the laser-exposed sites in 35 patients, and shed spontaneously about 3 weeks later. Post-inflammatory hyperpigmentation at the laser-exposed sites was observed in 4 patients, and gradually regressed after 2-month follow-up. Conclusions HMME-PDT therapy is effective for the treatment of PWS, with high safety and few adverse reactions. High-frequency ultrasound can be used for objectively evaluating the clinical efficacy of HMME-PDT therapy.

Objective To analyze the time of removing setons by observing 30 cases of the infliximab (IFX)combined drainage setons therapy in the treatment of perianal fistulising Crohn's disease.Methods Thirty patients of perianal fistulising Crohn's disease of Department of Colorectal Surgery,Jiangsu Prorince Hospital of TCM in Aug.2015 to Jul.2017 were treated with drainage setons followed by intravenous IFX injections according to the standard,and setons were removed after the third injection of IFX.The method of repeated measurement were adopted to record.Clinical symptoms,perianal manifestations,laboratory indexes,healing rate and general linear model and nonparametric test of SPSS 23.0 software were used for statistical analysis.Results The differences of WBC,CRP,ESR,HB,PLT,BMI,CDAI and PDAI between post treatment and pretreatment were statistically significant (P ＜ 0.05).WBC,CRP and ESR will rerise at some time after removing the rubber band (sixth week).The closure rate of fistular at the 14th week was 53.3％,and after the follow-up in the ward at 22th week and 30th week,the clinical efficacy of fistular was not statistically significant (P ＞0.05) at the 14th week,22th week and 30th week.Conclusion IFX combined drainage setons which was removed when the induction therapy finished can induce Crohn's disease remission,improve laboratory index and promote fistula closure.the clinical efficacy in short time was stable.

Objective To investigate the critical value of TSH-stimulated Tg(sTg) in the diagnosis of metastasis from DTC, and to evaluate the diagnostic value of the ratio of sTg to suppressed Tg (sTg/suppressed Tg).Methods A total of 330 post-operative DTC patients(87 males, 243 females, age range: 12-70 years)who underwent thyroid remnant ablation from August 2008 to December 2014 were retrospectively reviewed.Their serum TgAb levels were normal.The patients were divided into non-metastasis group(147 cases)and metastasis group(183 cases) according to results of ultrasonography, CT and WBS.The difference of sTg between the two groups were compared by Mann-Whitney rank sum test.ROC curve was used to analyze the relationship between sTg, sTg/suppressed Tg ratio and metastasis, the cutoff value was calculated.Results The sTg was significantly different between the non-metastasis group and metastasis group: 1.0 (0.1, 2.0) μg/L vs 36.5 (3.9, 126.7) μg/L;u=-6.642, P<0.05.The AUC for ROC curve in metastasis group was 0.85, and the cutoff value was 2.05 μg/L, with the sensitivity 85.2%, specificity 67.3%, and accuracy 82.3%.While sTg<2.05 μg/L, the AUC of sTg/suppressed Tg ratio was 0.941, and the cutoff value was 4.3, with the sensitivity 93.3%, specificity 88.2%, and accuracy 92.3%.Conclusions The sTg has a specific value for the diagnosis of metastasis from DTC after operation and the cutoff value is 2.05 μg/L in this set of patients.The ratio of sTg/suppressed Tg could be used to correct the sTg and to improve the diagnostic sensitivity.

Objective To evaluate the efficacy of infliximab combined with sphincter-sparing surgery in treatment of perianal Crohn's disease.Methods Clinical data of 49 patients with perianal Crohn's disease (3 cases with nonfistulizing perianal Crohn's disease and 46 cases with fistulizing perianal Crohn's disease) receiving infliximab combined with sphincter-sparing surgery in Jiangsu Province Hospital of TCM from May 2010 to June 2014 were analyzed retrospectively.The situation of fistula closure was assessed.C-reactive protein and perianal disease activity index were estimated by Wilcoxon method.Results No patient was failed to respond to primary treatment.patients (26/46) had a complete response to treatment,28.3％ patients (13/46) had a partial response and 15.2％ patients (7/46) had lost response to treatment;2 cases of anal ulcer healing;No other perianal lesion occurred in 1 case of verrucous skin.At final follow-up,CRP was decreased to [4.5 (1.5,15.9)] mg/Lfrom [16.9(6.6,35.6)] mg/L(Z=-3.994,P=0.00);PDAI was decreased to[1(0,4.5)]from [7(4.5,10.5)] (Z=-6.100,P=0.00).Conclusion Infliximab combined with sphincter-sparing surgery is effective for perianal Crohn's disease.

Objective To analyze the blood arsenic concentration and the safety of compound Qinghuang powder(compound QHP)in patients with myelodysplastic syndrome(MDS).Methods A total of 45 MDS patients received treatment with compound QHP (the treatment group, n=45). The concentration of blood arsenic in different time was determined by atomic fluorescence spectrometry. The clinical safety of compound QHP was evaluated by analyzing the symptoms of adverse reaction and organ function. The comparison were MDS patients with Qinghuang powder (QHP group, n=47) and healthy people. Results There was no significant difference of the blood arsenic concentration between the treatment group and the healthy control group (P=0.450),while after the treatment for 1 month those concentrations significantly increased (P=0.000). There were no significant difference between the blood arsenic concentration after treatment for 1, 3, and 6 months (P=0.240). The incidence of adverse reaction in the treatment group was significantly lower than that in QHP group(χ2=4.720, P=0.030). The incidence of adverse reactions in the digestive tract was significantly lower in the treatment group than that in QHP group (χ2=4.650, P=0.034). The blood arsenic concentration of patients with abdominal pain diarrhea was significantly lower than those without abdominal pain diarrhea (P=0.020). Before treatment in the compound QHP group, there were 21 cases with increased myocardial enzymes, 10 cases with abnormal liver function and 4 cases with renal dysfunction, respectively. After treatment at 6th month, these indicators returned to normal with 7 cases of myocardial enzymes, 6 cases of liver function and 1 case of renal function, respectively. There was no new case with abnormal myocardial enzymes, liver function and renal dysfunction, respectively. Conclusions Arsenic could be absorbed in the digestive tract into blood in MDS patients after treatment with arsenic-containing compound QHP, and the blood arsenic concentration remained stable during the course of treatment. The adverse reactions were mainly mild gastrointestinal symptoms, but no heart, liver or renal function damage was observed. The incidence of abdominal pain diarrhea in patients treated with compound QHP was significantly lower than that with QHP.

Objective To investigate the critical value of TSH-stimulated Tg(sTg) in the diagnosis of metastasis from DTC,and to evaluate the diagnostic value of the ratio of sTg to suppressed Tg (sTg/suppressed Tg).Methods A total of 330 post-operative DTC patients(87 males,243 females,age range:12-70 years)who underwent thyroid remnant ablation from August 2008 to December 2014 were retrospectively reviewed.Their serum TgAb levels were normal.The patients were divided into non-metastasis group (147 cases) and metastasis group(183 cases) according to results of ultrasonography,CT and WBS.The difference of sTg between the two groups were compared by Mann-Whitney rank sum test.ROC curve was used to analyze the relationship between sTg,sTg/suppressed Tg ratio and metastasis,the cutoff value was calculated.Results The sTg was significantly different between the non-metastasis group and metastasis group:1.0 (0.1,2.0) μg/L vs 36.5 (3.9,126.7) μg/L;u=-6.642,P＜0.05.The AUC for ROC curve in metastasis group was 0.85,and the cutoff value was 2.05 μg/L,with the sensitivity 85.2％,specificity 67.3％,and accuracy 82.3％.While sTg＜2.05 μg/L,the AUC of sTg/suppressed Tg ratio was 0.941,and the cutoff value was 4.3,with the sensitivity 93.3％,specificity 88.2％,and accuracy 92.3％.Conclusions The sTg has a specific value for the diagnosis of metastasis from DTC after operation and the cutoff value is 2.05 μg/L in this set of patients.The ratio of sTg/suppressed Tg could be used to correct the sTg and to improve the diagnostic sensitivity.

Objective To evaluate the effect of tirofiban injection in coronary artery occlusion by suction catheter on the opening time of the coronary artery occlusion , the improvement of the blood flow and the incidence of adverse events in 30 days. Methods A total of 97 patients with acute myocardial infarction in recent 4 years were included , whose culprit vessels were subtotal occlusion or total occlusion by angiography and were randomly divided into thrombus aspiration group (group A) and tirofiban injection in occlusion and thrombus aspiration group (group B). The opening time of the coronary artery, the improvement of the blood flow and the incidence of adverse events in 30 days were compared between two groups. Results The opening time of the coronary artery occlusion in group A was shortened when compared with group B but the blood flow arriving TIMI III grade in group B was shorter (P < 0.05). No-reflow incidence in group B was lower while the proportion of blood flow arriving TIMI III grade was higher than that in group A in early phase (P < 0.05). The incidence of adverse events in 30 days was decreased in group B when compared with group A ,but the difference wasn't statistically significant (P > 0.05). Conclusion Direct tirofiban injection in coronary artery occlusion could effectively shorten the opening time of the coronary artery occlusion reduce no-reflow incidence , and improve coronary perfusion but could not decrease the incidence of adverse cardiovascular events in 30 days.

Objective To investigate the clinical characteristics of perianal Crohn's disease (CD) with or without proctitis and compare the treatment effect of surgery combined with biological preparation.Methods The retrospective cohort study was conducted.The clinical data of 52 patients with perianal CD who were admitted to the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from June 2011 to October 2014 were collected.Thirty patients with inflammation involvement of the rectum and 22 patients without inflammation involvement of the rectum were respectively divided into the proctitis group and non-proctitis group.All the 52 patients underwent surgery combined with infliximab therapy.Observation indicators included:(1) clinical characteristics:gender,age,body mass index (BMI),lesion location,disease behavior,type of perianal lesions,history of perianal surgeries,CD activity index (CDAI),perianal disease activity index (PDAI),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC),platelet (PLT) and albumin (Alb),(2) treatment and follow-up.Follow-up using outpatient examination was performed to evaluate the perianal lesions up to December 2015.Measurement data with normal distribution were described as-x ± s and comparison between groups was analyzed by the t test.Count data were described as the percentage,and comparison between groups was analyzed by the chi-square test and Fisher's exact probability.Results (1)Clinical characteristics:number of patients with BMI ＜ 18.5 kg/m2 and with normal BMI were respectively 17,13 in the proctitis group and 6,16 in the non-proctitis group.Lesions located at ileum,colon and ileocolon were respectively detected in 3,9,18 patients in the proctitis group and 9,4,9 patients in the non-proctitis group.CDAI≥ 150 and ＜ 150,CRP≥8 mg/L and ＜ 8 mg/L,ESR ＞ normal level and =normal level,Alb ＜ 35 g/L and between 35 g/L and 50 g/L were respectively detected in 23,7,25,5,24,6,12,18 patients in the proctitis group and 8,14,8,14,8,14,2,20 in the non-proctitis group,with statistically significant differences between the 2 groups (x2 =4.446,6.855,8.563,12.076,10.211,6.163,P ＜ 0.05).(2) Treatment and follow-up:all the 52 patients underwent more than 3 times infliximab therapies and perianal surgeries within 1 week after infliximab therapy.All the patients were followed up for a median time of 28 months (range,8-52 months).Thirty-four patients still underwent maintenance therapy of immunosuppressive agents and 18 didn't undergo maintenance therapy up to the end of follow-up.Twenty-two patients in the proctitis group and 12 patients in the non-proctitis group underwent maintenance therapy,with no statistically significant difference between the 2 groups (x2 =1.979,P ＞ 0.05).The total healed rate,improvement rate and unhealed rate of perianal lesion were 55.8％ (29/52),34.6％ (18/52) and 9.6％ (5/52),respectively.The number of patients with healed,improved and unhealed perianal lesions were 16,11,3 in the proctitis group and 13,7,2 in the non-proctitis group,respectively,showing no significant difference in treatment effects between the 2 groups (x2 =O.173,P ＞ 0.05).Conclusions Patients with perianal CD combined with proctitis have higher activity of intestinal inflammation and worse nutritional status compared with patients without proctitis.However,there is no significant difference in the type and activity of perianal lesion between patients with or without proctitis.Surgery combined with biological preparation could render better clinical outcomes in treatment of perianal CD with proctitis.