Objective:To explore the effects of self-made Huoxue Xiaozhong Xunxi Decoction combined with functional exercise on postoperative swelling of affected limbs, bone metabolism and recovery of knee function in patients with traumatic fracture of tibial plateau (FTP).Methods:Randomized controlled trial. totally 80 patients after FTP surgery in the Qidong Hospital of Traditional Chinese Medicine were enrolled and divided into two groups by random number table method from January 2018 to January 2022, with 40 cases in each group. After surgery, control group was treated with functional exercise, while observation group was additionally treated with self-made Huoxue Xiaozhong Xunxi Decoction. All were treated continuously for 8 weeks. The perioperative indexes (operation time, incision length, intraoperative blood loss, postoperative drainage volume, leaving bed time) in the two groups were recorded. The postoperative swelling and pain of affected limbs were observed, and detumescence time, pain relief time, fracture healing time and complete weight-bearing time were recorded. The knee function was evaluated by Hospital for Special Surgery (HSS). The level of serum bone morphogenetic protein-2 (BMP-2) was detected by ELISA, and total n-terminal propeptide of typeⅠprecollagen (t-PINP) and β-crossLaps (β-CTX) were detected by full-automatic immunoluminescence analyzer. The occurrence of postoperative complications in the two groups was recorded.Results:There was no significant difference in operation time, incision length, intraoperative blood loss, postoperative drainage volume or leaving bed time between the two groups ( P>0.05). The total effective rate of the observation group was 97.5% (39/40), while the control group was 80.0% (32/40), with statistical significance ( χ2=6.14, P=0.013). The detumescence time, pain relief time, fracture healing time and complete weight-bearing time were earlier in the observation group than control group ( P<0.01). After 10 d of treatment, VAS score and swelling degree in observation group were lower than those in the control group ( t=7.05, 3.81, P<0.01). After 8 weeks of treatment, levels of serum BMP-2 [(625.16±67.43) μg/L vs. (542.35±53.27) μg/L, t=6.10], t-PINP [(54.16±7.29) μg/L vs. (50.34±6.12) μg/L, t=2.54] and β-CTX [(1.26±0.38) μg/L vs. (1.04±0.23) μg/L, t=3.13] in observation group were higher than those in the control group ( P<0.05). During treatment, the incidence of complications in the observation group was 2.5% (1/40) and the control group was 7.5% (3/40), without statistical significance ( χ2=1.05, P=0.305). Conclusion:Self-made Huoxue Xiaozhong Xunxi Decoction combined with functional exercise is beneficial to improve pain and swelling of affected limbs and bone metabolism, and promote the recovery of knee function in patients after FTP surgery.

Objective To investigate the clinical efficacy of atorvastatin combined with trimetazidine in the treatment of coronary heart disease .Methods 80 patients with coronary heart disease were selected as the research subjects.80 patients were randomly divided into two groups .The observation group was given atorvastatin combined with trimetazidine .The control group was treated with trimetazidine .The clinical efficacy ,serum lipids levels ,hemody-namic changes and adverse reaction were observed and evaluated .Results The observation group had markedly effective in 31 cases,effective in 7 cases,ineffective in all cases ,the total effective rate was 95.0％,which was signifi-cantly higher than 77.5％of the control group(effective in 10 cases,ineffective in 9 cases,χ2 =6.818,P<0.05). The levels of TG,TC,LDL-C,HDL-C in the observation group were (1.2 ±0.2) mmol/L,(2.4 ±1.0) mmol/L, (1.5 ±0.0) mmol/L,(0.7 ±0.1) mmol/L,which in the control group were (1.6 ±0.1) mmol/L,(3.59 ± 1.2)mmol/L,(2.2 ±0.1)mmol/L,(0.9 ±0.2)mmol/L,the serum lipids levels between the two groups had statisti-cally significant differences (t =5.41,3.47,4.87,2.05,P<0.05).The whole blood viscosity (low cut),blood viscosity(high cut),plasma viscosity of the observation group were (6.98 ±0.23)mPa· s,(5.07 ±0.13)mPa· s, (1.21 ±0.12) mPa· s,which were significantly lower than those of the control group [(9.01 ±0.21) mPa· s, (6.01 ±0.01)mPa· s,(1.54 ±0.21)mPa· s,t=5.24,4.47,5.44,all P<0.05].In the observation group,0 case of dizziness,1 case of skin rash,nausea and vomiting in 1 case,the incidence rate of adverse reactions was 5.0％.In the control group,2 cases of dizziness,3 cases of skin rash,nausea and vomiting in 4 cases,the incidence rate of adverse reaction was 22.5％,there was no statistically significant difference between the two groups (χ2 =0.867,P>0.05).Conclusion The clinical curative effect of atorvastatin combined with trimetazidine in the treatment of coro -nary heart disease is accurate ,it can reduce blood fat,improve the abnormal blood rheology ,and it is safe,with less adverse reactions ,which is worthy of application and promotion .

Objective To investigate the clinicopathological characteristics and prognostic factors of hepatoid adenocarcinoma of the stomach (HAS).Methods From Jan 2006 to Jan 2016,the clinical pathological data of 15 HAS cases in our hospital were analyzed retrospectively.60 TNM stage matched cases of non-HAS gastric cancer served as the control group.The clinical pathology factors and prognosis were compared between the two groups.Results Serum AFP positive HAS patients accounted for 87％.The serum level of AFP in HAS were significantly higher than that in controls (P ＜0.001).HAS was more prone to lymphatic invasion (73％ vs.33％,x2 =7.918,P =0.005) and vascular invasion (40％ vs.10％,x2 =8.036,P =0.005) than control gastric cancer.The immunohistochemistry positive rates of AFP,Glypican3,Hepatocyte and CEA in HAS were 87％,87％,33％,53％ respectively.Liver metastasis (53％ vs.12％,P =0.001) and other distant metastases (53％ vs.15％,P =0.004) were higher in the HAS.HAS median survival time was significantly lower (28.0 months vs.50.7 months,x2 =4.350,P =0.037).Postoperative HAS 1,3 and 5 years survival rates were 80％,33％ and 20％,respectively,significantly worse than 97％,78％ and 33％ in control group (x2 =5.525,17.198,5.472,P =0.019,0.000,0.019 respectively).The independent risk factor influencing the prognosis of HAS included TNM stage,vascular invasion,distant metastasis.Conclusions HAS is often complicated with higher serum AFP and prone to vascular invasion,lymph node metastasis and distant metastasis,hence a poorer prognosis.

Objective:To analyse the evaluation and experience of clinical effect of minimally invasive drainage and craniotomy in the treatment of patient with epidural hematoa.Methods:100 cases of patients who were diagnosed as epidural hematoma from January 2015 to January 2016 were selected and randomly divided into two groups,where the control group were given craniotomy,and the observation group were given minimal invasive drainage.The effect of the surgery and the life qualities before and after treatment of the two groups were compared.Results:The effect of observation group is better than that of control group (P ＜ 0.05);craniocerebral defect and the re-hemorrhage incidence occurrence in the observation group were obviously lower than those in the control group,(0 ％,6 ％ vs 12 ％,20 ％) (P＜0.05).Conclusion:Compared with craniotomy,minimal invasive drainage in clinical treatment of epidural hematoma showed advantage in at smaller trauma,faster recovery,and better effect,thus deserving further promotion of clinic application.

Background:Inflammation-based indexes have been used to predict survival and recurrence in cancer patients.Systemic immune-inflammation index (SII) was reported to be associated with prognosis in some malignant tumors.In the present study,we aimed to explore the association between SII and the prognosis of patients with gastric cancer.Methods:We retrospectively analyzed data from 444 gastric cancer patients who underwent gastrectomy at the First Affiliated Hospital of Sun Yat-sen University between January 1994 and December 2005.Preoperative SII was calculated.The Chi square test or Fisher's exact test was used to determine the relationship between preoperative SII and clinicopathologic characteristics.Overall survival (OS) rates were estimated using the Kaplan-Meier method,and the effect of SII on OS was analyzed using the Cox proportional hazards model.Receiver operating characteristic (ROC) curves were used to compare the predictive ability of SII,NLR,and PLR.Results:SII equal to or higher than 660 was significantly associated with old age,large tumor size,unfavorable Borrmann classification,advanced tumor invasion,lymph node metastasis,distant metastasis,advanced TNM stage,and high carcino-embryonic antigen level,high neutrophil-lymphocyte ratio,and high platelet-lymphocyte ratio (all P ＜ 0.05).High SII was significantly associated with unfavorable prognosis (P ＜ 0.001) and SII was an independent predictor for OS (P =0.015).Subgroups analysis further showed significant associations between high SII and short OS in stage Ⅰ,Ⅱ,Ⅲ subgroups (all P ＜ 0.05).SII was superior to NLR and PLR for predicting OS in patients with gastric cancer.Conclusion:Preoperative SII level is an independent prognostic factor for OS in patients with gastric cancer.

Objective To summarise the clinicopathologic features and survival of gastric cancer at different tumor locations.Methods A total of 942 adult gastric cancer patients undergoing curative gastrectomy with lymphadenectomy were recruited from the First Affiliated Hospital,Sun Yat-sen University,and examined retrospectively.In all cases,patients' age,gender,pTNM stage and survival time were identified and recorded.Results There were 208 carcinoma cases at gastroesophageal junction (GEJ,22.1％),261 fundus/body cases (27.7％),445 antrum/pylorus cases (47.2％) and 28 whole stomach cases (3.0％).Compared with fundus/body and antrum/pylorus carcinoma,GEJ carcinomas were more often seen in males,among older patients,with larger tumor size and deeper infiltrated tumors,higher stage and worse 5-year disease-free survivals.Whole stomach carcinoma had predilection in female,younger patients,and at later stages and worst 5-year disease-free survival.Conclusions Gastric carcinomas differ greatly in biologic behavior and prognosis by anatomic locations.GEJ carcinoma has independent biologic features.Whole stomach carcinoma is of the highest malignancy and worst prognosis.

OBJECTIVETo evaluate the rationality of T staging of gastric cancer with transverse mesocolon invasion.

METHODSData of 808 patients with primary gastric cancer undergoing surgical treatment was screened from the Data base of Gastric Cancer of Sun Yat-sen University, from April 1996 to October 2009. According to the information of transverse mesocolon invasion, all cases were divided into groups NOI (T4a stage, non organ invasion, n = 638), NTMI (T4b stage, non transverse mesolon invasion, with organ invasion, n = 126), and TMI (transverse mesocolon invasion, n = 44). The clinicopathological features, surgical procedure and prognosis were compared among the three groups.

RESULTSNo significant difference was found in gender, age, lymph node metastasis, hepatic metastasis, tumor's Borrmann type, histological type, differentiation degree, value of serum CEA among the 3 groups (all P > 0.05). In the groups NOI, NTMI and TMI, the ratio of mean tumor diameter ≥ 5 cm was 39.0% (249/638), 61.1% (77/126) and 54.5% (24/44), respectively; the ratio of distal metastasis was 11.9% (76/638), 30.2% (38/126) and 43.2% (19/44), respectively; the ratio of peritoneal metastasis was 8.2% (52/638), 26.2% (33/126) and 38.6% (17/44), respectively; the ratio of TNM IV stage was 25.4% (162/638), 84.7% (107/126) and 93.7% (41/44), respectively; and the ratio of radical resection was 92.0% (587/638), 69.8% (88/126) and 77.3% (34/44), respectively; all with significant differences (P < 0.01), and the results of pairwise comparisons (Bonferroni correction, significant level α = 0.05/3 = 0.0167) showed that these parameters were significantly different between groups NOI and TMI (P < 0.0167), but non-significant between groups NTMI and TMI (P > 0.0167). The median survival time was 42.0, 16.4 and 19.0 months in the groups NOI, NTMI and TMI, respectively (P < 0.01), and the results of pairwise comparison showed that the prognosis were significant different between the groups NOI and TMI (P < 0.01), but non-significant between the groups NTMI and TMI (P > 0.05). In the cases who received radical resection, the median survival time was 47.9, 23.5 and 21.4 months in the groups NOI, NTMI and TMI, respectively (P < 0.01), and the results of pairwise comparison showed that the prognosis was significantly different between the groups NOI and TMI (P < 0.05), but not significant between groups NTMI and TMI (P > 0.05).

CONCLUSIONSThe tumor size, distal meatastasis, peritoneal metastasis, TNM stage, surgical procedure and prognosis of gastric cancer with transverse mesocolon invasion are similar to that of T4b gastric cancer, but are significantly different from that of T4a gastric cancer. Gastric cancer with transverse mesocolon invasion should be reclassified as T4b stage.

Colonic Neoplasms ; pathology ; Humans ; Mesocolon ; pathology ; Neoplasm Staging ; Stomach ; pathology ; Stomach Neoplasms ; pathology

OBJECTIVETo investigate the expression and significance of miR-125a and anti-apoptotic protein Mcl-1 in intestinal tissue after massive small bowel resection in intestinal adaptation.

METHODSSprague-Dawley rats (54 male rats, 8-week old) were divided into 3 groups randomly, including two control groups. Rats in the experiment group were subjected to 70% massive small bowel resection. Rats in the resection group underwent simple intestinal resection and anastomosis. Rats in the control group underwent laparotomy alone. A 5 cm intestine approximately 1 cm distal to the anastomosis was harvested a week after operation. Expression of Mcl-1 was assessed by immunohistochemistry and real-time PCR was used to detect the expression of miR-125a in intestinal tissue.

RESULTSThe positive expression of Mcl-1 in the experiment group was 18.8%(3/16), significantly lower than that in the control group(76.5%, 13/17) and the resection group (83.33%, 15/18)(both P<0.01). The expression of miR-125a in the experiment group was 1.92, significantly higher than that in the control group (1.01) and the resection group (1.05)(both P<0.01).

CONCLUSIONmiR-125a and anti-apoptotic protein Mcl-1 may play an important role in intestinal adaptation process and they may regulate each other through a certain pathway.

Anastomosis, Surgical ; Animals ; Disease Models, Animal ; Intestine, Small ; metabolism ; surgery ; Male ; MicroRNAs ; metabolism ; Myeloid Cell Leukemia Sequence 1 Protein ; metabolism ; Rats ; Rats, Sprague-Dawley ; Short Bowel Syndrome ; metabolism

OBJECTIVETo investigate the feasibility and short-term efficacy of laparoscopic resection of primary local gastric and intestinal gastrointestinal stromal tumors(GIST).

METHODSClinicopathological data of 26 patients with GIST, 20 located at the stomach and 6 at the intestine, undergoing laparoscopic complete resection from October 2010 to April 2013 were retrospectively analyzed.

RESULTSHand-assisted laparoscopic surgery was performed in 3 patients with gastric GIST, while the other 23 underwent regular laparoscopic surgery. All the procedures were performed successfully without conversion to open operation. According to tumor location and growth types, gastric local resection was performed in 18 cases, distal gastrectomy in 2 cases and intestinal segmental resection in all 6 cases of intestinal GIST. The mean diameter of tumor was (4.5±1.6) cm. The mean operational time was(96.2±28.2) min, with a mean blood loss of (49.6±38.6) ml. Postoperative bowel function recovery time was (2.3±0.7) d and the length of postoperative hospital stay was (6.8±1.9) d. Bleeding from gastrointestinal tract developed in 1 patient after resection of intestinal GIST. Postoperative pathology indicated very low risk of GIST in 1(3.8%), low risk in 13(50.0%), intermediate in 9(34.6%) and high risk in 3(11.5%) patients, respectively. After a follow-up ranging form 3 to 32 months, no recurrence or death was found.

CONCLUSIONLaparoscopic surgery of primary local GISTs from stomach or intestine is safe and feasible in selected patients, with less invasiveness, rapid recovery, and favorable short-term outcomes.

Gastrectomy ; Gastrointestinal Stromal Tumors ; surgery ; Hand-Assisted Laparoscopy ; Humans ; Intestinal Neoplasms ; surgery ; Laparoscopy ; Length of Stay ; Neoplasm Recurrence, Local ; Operative Time ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

Objective To investigate the feasibility and short-term efficacy of laparoscopic resection of primary local gastric and intestinal gastrointestinal stromal tumors (GIST). Methods Clinicopathological data of 26 patients with GIST, 20 located at the stomach and 6 at the intestine, undergoing laparoscopic complete resection from October 2010 to April 2013 were retrospectively analyzed. Results Hand-assisted laparoscopic surgery was performed in 3 patients with gastric GIST , while the other 23 underwent regular laparoscopic surgery. All the procedures were performed successfully without conversion to open operation. According to tumor location and growth types , gastric local resection was performed in 18 cases , distal gastrectomy in 2 cases and intestinal segmental resection in all 6 cases of intestinal GIST. The mean diameter of tumor was (4.5±1.6) cm. The mean operational time was (96.2 ±28.2) min, with a mean blood loss of (49.6 ±38.6) ml. Postoperative bowel function recovery time was(2.3±0.7) d and the length of postoperative hospital stay was (6.8± 1.9) d. Bleeding from gastrointestinal tract developed in 1 patient after resection of intestinal GIST. Postoperative pathology indicated very low risk of GIST in 1 (3.8%), low risk in 13 (50.0%), intermediate in 9 (34.6%) and high risk in 3 (11.5%) patients, respectively. After a follow-up ranging form 3 to 32 months, no recurrence or death was found. Conclusion Laparoscopic surgery of primary local GISTs from stomach or intestine is safe and feasible in selected patients, with less invasiveness, rapid recovery, and favorable short-term outcomes.