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??Influence of enhanced recovery after surgery for radical resection of gastric cancer on immune function??a Meta-analysis WANG Xiang-an, YU Li-ming, FAN Ji-chang, et al. Department of Gastrointestinal Surgery, the Second Affiliated Hospital, Nanchang University, Nanchang 330006, China
Corresponding author??YANG Gang, E-mail??ygrealtom@sohu.com
Abstract Objective To evaluate the influence of enhanced recovery after surgery (ERAS) for radical resection of gastric cancer on immune function. Methods The major domestic and foreign databases were searched to collect the literatures of randomized controlled trial (RCT) about the the comparison of ERAS and conventional perioperative care in radical resection of gastric cancer published by December, 2014 in both Chinese and English. After screening for inclusion, quality assessment and data extraction, Meta-analysis was conducted by the Review Manager 5.2 software. Results Sixteen studies involving 1101 patients were selected finally, with 563 patients in ERAS group and 538 patients in control group. Results of Meta-analysis showed that the levels of IL-6 on postoperative day (POD) 1, 3 and TNF- α on POD3 and CRP on POD1, 3, 7 in ERAS group were lower than those in control group significantly (all P<0.05) . Those on the rest of the days showed no significant difference (all P>0.05). The levels of IgA on POD1, 3, 7 and IgG on POD3, 6, 7 in ERAS group were higher than those in control group significantly (all P<0.05). But, the levels of IgM on POD1, 3, 7 showed no significant difference between the two groups (all P>0.05) . Conclusion ERAS for radical resection of gastric cancer can decrease the inflammatory responses and preserve immune function of bodys compared with conventional perioperative care.     

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??Learning curve of laparscopic resection in rectal cancer for experienced surgeon ZHU Xiao-ming??LOU Zheng??GONG Hai-feng??et al. Department of Colorectal Surgery??Changhai Hospital??the Second Military Medical University??Shanghai 200433??China
Corresponding author??ZHANG Wei??E-mail: weizhang2000cn@163.com
Abstract Objective To investigate how experienced surgeons in open surgery can quickly learn laparscopic resection for rectal cancer. Methods The clinical data of 120 cases of laparscopic resection for rectal cancer performed by the same team of surgeons from August 2009 to April 2015 in Changhai Hospital of the Second Military Medical University were analyzed retrospectively. The cases were divided into three groups (40 cases in each group) by operative sequence. The time span was 36, 19, 11 months respectively. The operating time??blood loss??the rate of conversion to open operation??number of lymph nodes??the integrityof mesorectum??postoperative aerofluxus time??postoperative hospital stay and the rate of postoperative complications were compared among the 3 groups. Results The operating time in group A was ??162.9±36.7??min??which as much higher than that in group B ??147.0±36.8??min and group C (132.7±31.9)min (P<0.05). However??there was no significant difference between group B and C (P>0.05). Intraoperative blood loss??the rate of conversion to open operation and postoperative hospital stay in group A had no significant difference compared with those in group B and C (P??0.05). Also??there was no significant difference in the integrity of mesorectum??number of lymph nodes??postoperative aerofluxus time and the rate of postoperative complications among 3 gourps ??P>0.05??. Conclusion From the learning curve??surgeons with rich experience in open surgery can learn laparscopic skills for rectal cancer after performing 40 cases.     

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??Minimally invasive interventional therapy of colorectal liver metastases ZHANG Hang-yu, ZHU Xu, GUO Jian-hai. Department of Interventional Therapy, Peking University School of Oncology, Beijing Cancer Hospital & Institute; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
Corresponding author:ZHU Xu,E-mail:drzhuxu@163.com
Abstract Compared with systemic chemotherapy and surgery, minimally invasive interventional therapy has the advantages of repeatable, minimally invasive and high local control rate. With the development of technology and the update of clinical evidence, minimally invasive interventional therapy in the multidisciplinary team (MDT) has gain more acceptance.For the tumor feeding artery administration, interventional treatment via the vascular as a second-line treatment after systemic treatment failure has been recommended by the Guide. It can not only improve the tumor local control effect, but also reduce the toxicity of chemotherapy drugs. Non vascular minimally invasive treatment as a necessary complement to the comprehensive treatment of colorectal liver metastases, the reasonable choice of indications can obtain unparalleled curative effect compared with systemic chemotherapy and surgery. However , systemic treatment must be considered when making the choice of the local treatment methods.     

椎管内神经鞘瘤的MR诊断

目的 探讨椎管内神经鞘瘤的MR特征。经鞘瘤的MR表现及手术病理资料，并复习文献。结果 方法回顾性分析34例经手术病理证实，资料完整的椎管内神16例囊变，全部病例T1加权为均匀或不均匀低信号，T2加权图像为高信号，27例T2加权信号不均匀，全部病例明显强化，边界清楚，27例不均匀强化，其中17例呈外围强化。结论 T1加权图像低信号，T2加权不均匀高信号，明显强化，边界清楚，外围强化，囊变是椎管内神经鞘瘤的特征。     

儿保管理在早产低出生体重儿中的应用效果

目的探讨儿保管理在早产低出生体重儿中的应用效果。方法选取2019年1月~2020年2月我院收治的66例早产低出生体重儿为研究对象,按照收治时间分为对照组和观察组,各33例。对照组给予常规管理,观察组给予儿保管理,观察两组早产低出生体重儿的体重提升效果及转正管理情况。结果观察组早产低出生体重儿的体重提升有效率(93.94%)高于对照组(78.79%)(P<0.05);管理干预后,观察组33例早产低出生体重儿均结案并转为正常儿管理,对照组有32例低体重儿结案转为正常儿管理。结论儿保管理应用于早产低出生体重儿,可有效促进其体重增长,使其尽快达到正常出生体重儿,为后期的健康生长发育奠定扎实的基础,具有较高的临床推广价值。     

模拟复用的医用外科口罩清洗和消毒后主要性能指标变化

目的 医用外科口罩模拟复用清洗和消毒后主要性能指标变化。方法 以颗粒过滤效率（PFE）、细菌过滤效率（BFE）作为医用外科口罩的关键性能指标,对不同佩戴时间、不同干燥方式、不同洗消方式等试验条件进行验证。结果 试验后的医用外科口罩关键性能指标能够符合标准要求。结论 医用外科口罩采用清水洗涤、56℃热水浸泡和100℃沸水浸泡处理后主要性能指标未见明显下降。     

过量服用木通、仙鹤草致肾功能衰竭各1例

患者女,72岁,农民,2002年6月因双手指关节红肿热痛7d,在当地个体诊所就医,配给单味中药木通3剂,每剂50g,每天1剂,1剂两煎,服用第1剂后感到胃部不适,服用第2剂第1煎时即感恶心,第2煎就未曾服用。随后出现纳差伴四肢无力,此后未服用木通及其他药物,也未见双手症状改善。1周后出现小便次数和尿量减少,来院查尿常规示蛋白质+,肾功能示尿素氮9.83mmol/L、肌酐472.3μmol/L,考虑为药物性肾功能衰竭,入住我院内科治疗。入院3d后复查尿常规示蛋白质+,肾功能示尿素氮8.66mmol/L,肌酐468.2μmol/L,1周后复查尿常规示蛋白质+,肾功能示尿素氮8.23mmol/…     

大黄治疗心血管疾病的药理学研究浅识

大黄是中药传统的泻下药，其作用广泛，近年来在心血管研究方面也取得了很大进展。为开发大黄新用途，拓展其在临床的应用，本文综述了大黄及其有效成分的心血管药理作用及作用机制。     

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??Risk factors for early postoperative complication after ileal/ileocecal resection for chronic radiation enteritis with small bowel obstruction GONG Jian-feng, ZHU Wei-ming, YU Wen-kui, et al. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA, Medical College of Nanjing University, Nanjing 210002, China
Corresponding author ??LI Ning, E-mail: liningrigs@yahoo.com.cn
Abstract Objective To identify the perioperative complication incidence and its risk factors in patients underwent ileal/ileocecal resection for chronic radiation enteritis (CRE) with small bowel obstruction. Methods Univariate and multivariate analysis of a retrospectively gathered database between June 2001 and December 2011 in Department of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA were performed on a cohort of patients (n=158) underwent ileal/ileocecal resection for CRE obstruction at a single institution. Altogether, we analyzed 33 potential risk factors to identify significant influence on the postoperative outcome. Results Overall and major morbidity rates were 57.0% (90 patients) and 28.5% (45 patients), respectively. The mortality rate was 1.9% (3 patients). Univariate analysis determined that ASA score of not less than 3, anemia, low platelet level, long operation time, intraoperative transfusion, presence of radiation uropathy and proctitis and experience of surgeons were important risk factors for Grade ??-?? morbidity. Multivariate analysis found ASA score of not less than 3, anemia, intraoperative transfusion, low platelet level, radiation uropathy and surgeon’s experience as independent risk factors for Grade ??-?? morbidity. Conclusion The current study provides the first evidence of predictive risk factors for postoperative morbidity of ileal/ileocecal resection for CRE.