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Sepsis is a systemic inflammatory syndrome induced by infection and other factors， with the number of patients worldwide exceeding 10 million each year. The pathophysiological mechanism is of this disease complex. Sepsis is often accompanied by endotoxin translocation， gastrointestinal dysfunction， inflammatory cytokine activation， immune dysregulation， coagulation disorder， multiple organ function impairment and many other body imbalances， as well as systemic inflammation， apoptosis， oxidative stress injury and other cell damage mechanisms. This disease causes a heavy medical burden due to the difficult diagnosis and treatment and the poor prognosis. Great progress has been achieved in the diagnosis and treatment of sepsis with traditional Chinese medicine （TCM） and western medicine. The value of western medicine in the diagnosis and treatment of sepsis is limited due to antibiotic resistance， hormone abuse， and high medical costs. Sepsis is classified as a warm disease or typhoid fever in TCM. Da Chengqitang is a classical formula in the Treatise on Typhoid Fever to deal with the excess syndrome of Yang brightness Fu-organ. Modern medicine has proved that Da Chengqitang has the effect of inhibiting oxidative stress， reducing inflammation， and delaying apoptosis by improving gastrointestinal dynamics and regulating intestinal microecology. On the basis of the previous theoretical basis and the rich experience in the medication， medical practitioners have proposed a new therapeutic concept of using Da Chengqitang in combination with western drugs from a holistic view involving both bacteria and toxicity for treating both the symptoms and the root cause， which has a wide range of application. The article reviews the classical research and latest findings of Da Chengqitang in the treatment of sepsis， with a view to clarifying the mechanism and advantages of this formula in the adjuvant treatment of sepsis， exploring its potential efficacy， and providing timely， adequate， and scientific theoretical support for the promotion of this formula in the clinical practice.
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Objective:To evaluate the aesthetic outcome of the pretarsal orbicularis-tarsus fixation technique in incisional double eyelid blepharoplasty.Methods:Postoperative results were evaluated from 798 patients who underwent the orbicularis-tarsus fixation blepharoplasty from January 2015 to December 2018. Based on an incisional maneuver, soft tissue was carefully removed to expose the superior edge of tarsus, then the pretarsal orbicularis oculi muscle was anchored on the tarsus. For skin closure, both skin margins, a small bite of subcutaneous tissue and the pretarsal fascia were interruptedly sutured to enhance cicatricial adhesion.Results:All patients successfully underwent double eyelidplasty using this modified technique. The follow-up period ranged from two to forty-six months, with a mean period of twenty months. Ninety-six percent of the patients were satisfied with postoperative outcomes. Twenty-two cases of palpebral fold asymmetry and ten cases of unsatisfactory fold formation near the inner canthus were encountered. However, all the defects had been well improved by minor revisions. No supratarsal crease drooping or disappearing, suture spitting out, scar hypertrophy or crease depression were observed postoperatively.Conclusions:The orbicularis-tarsus fixation method is a reliable technique for double eyelid plasty. It enables high feasibility and long-lasting result, with lower risk of postoperative complications.
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Objective:To analyze the epidemiological features of geriatric humeral surgical neck fractures from 2010 through 2019 in The Third Hospital of Hebei Medical University.Methods:A retrospective study was conducted of the data of the inpatients aged ≥60 years who had been treated for humeral surgical neck fractures in The Third Hospital of Hebei Medical University from 2010 through 2019. The patients were divided into 2 groups by the year of admission: the former five-year group (group A from January 1, 2010 to December 31, 2014) and latter five-year group (group B from January 1, 2015 to December 31, 2019). The data of the patients were compared between the 2 groups to find the epidemiological characteristics and trends of the humeral surgical neck fractures in the 10-year period.Results:A total of 312 geriatric humeral surgical neck fractures were included, accounting for 1.2%(312/25, 764) of the upper limb fractures and 0.4% (312/88, 886) of all the fractures in the same period. There were 64 males and 248 females, giving a male/female ratio of 0.26∶1. Their ages ranged from 60 to 93 years. The peak age of the fractures was from 60 to 69 years for both males and females. Falls and indoor activity injuries accounted for the largest proportion (71.2%, 222/312). The common fracture types were 11-A2 and 11-A3. The proportion of overweight and obese patients by the body mass index (BMI) was the largest (58.7%, 183/312). There were no statistically significant differences between groups A and B in male/female ratio (0.37:1 versus 0.22:1) or in proportion of peak age patients [42.7% (38/89) versus 55.2% (123/223)] ( P>0.05). There were statistically significant differences between the 2 groups in injury causes, fracture types and BMI distribution ( P<0.05). Conclusions:The geriatric humeral surgical neck fractures accounted for 1.2% of the upper limb fractures and 0.4% of all the fractures in the same period. There were more female patients than male ones. Falls and indoor activity injuries were the most common causes. The proportions of complex fractures and overweight and obese patients increased.
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Objective:To explore the effect of Dachengqi Decoction and enteral nutrition on the recovery of gastrointestinal function in patients with gastric cancer.Methods:From September 2018 to September 2019, 100 patients with gastric cancer undergoing radical gastrectomy in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were selected as the research objects, and were divided into observation group and control group according to the random number table method, each group contained 50 cases. Among them, the control group was given routine diet before operation to provide pre adaptation of enteral nutrient solution; the observation group was added with Dachengqi Decoction on the basis of routine diet. The recovery of gastrointestinal function, plasma motilin (MTL), serum gastrin (GAS) and gastrointestinal complications were observed and compared between the two groups.Results:There were 3 cases of abdominal distention and diarrhea in the control group, 1 case of diarrhea and 1 case of nausea and vomiting in the control group. The total incidence of gastrointestinal complications was 16% (8/50). There was 1 case of abdominal distention and 1 case of diarrhea in the observation group, and the total incidence of gastrointestinal complications was 4%(2/50). The difference between the two groups was statistically significant ( χ2 value was 4.000, P<0.05). In the observation group, the time of first bowel sounds, exhaust time and defecation time were (26.12 ± 5.32) h, (25.49 ± 4.49) h, (32.63 ± 4.31) h, respectively, which were significantly shorter than those in the control group (32.24 ± 6.41) h, (46.74 ± 6.14) h, (49.51 ± 6.28) h, and the difference was statistically significant ( t value was 5.195, 19.754, 15.671, P<0.05). The plasma MTL and serum gas in the observation group were (346.54 ± 18.58) ng/L, (123.44 ± 6.19) ng/L. After operation, the results were (247.24 ± 11.40) ng/L, (85.46 ± 5.12) ng/L. The difference was statistically significant ( t value was 97.793, 250.990, P<0.05). The plasma MTL and serum gas of the control group before operation were (344.63±16.65) ng/L and (122.53 ± 6.35) ng/L respectively. After operation, the results were (205.84±10.21)ng/L, (64.79±5.24) ng/L. The difference was statistically significant ( t value was 152.390, 367.823, P<0.05). The levels of plasma MTL and serum gas in the observation group were significantly higher than those in the control group ( t value was 19.129, 19.95, P<0.05). Conclusions:The modified Dachengqi Decoction and the pre adaptation of enteral nutrition solution are helpful to reduce the occurrence of various gastrointestinal complications after gastric cancer operation and promote the rapid recovery of gastrointestinal function, which may be related to the promotion of the secretion of MTL and gas.
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Objective:To analyze the epidemiological characteristics of all the patients with intertrochanteric fracture admitted to the Third Hospital of Heibei Medical University in the past 10 years.Methods:Data of patients with intertrochanteric fracture admitted to our hospital from January 1, 2010 to December 31, 2019 were retrospectively analyzed. According to the year of admission, all the patients were divided into two groups: the first five years (group A) and the last five years (group B). Gender, age, injury cause, Evans classification, complicated diseases, length of hospital stay and whether surgical treatment or not were compared.Results:A total of 6,125 patients with intertrochanteric fracture were included in the study, including 2,664 males and 3,461 females with a male to female ratio of 0.77∶1. The peak age was 70-79 for males and 80-89 for females. There were 2,314 cases in group A (male to female ratio was 0.91∶1) and 3,811 cases in group B (0.70∶1), showing significant differences between the 2 groups in the male to female ratio ( χ2=25.265, P< 0.05). The peak age ranged from 70 to 80 years (31.9%,739/2,314) in group A and from 80 to 90 years (34.5%, 1,313/3,811) in group B. There were significant differences between the 2 groups in the sex ratios of age groups from 70 to 79 years ( χ2=0.024, P< 0.05). In all the 6,152 patients with a definite injury cause, the fall and indoor activity accounted for the highest proportion (83.9%, 5,140/6,125), and the proportion of group A was 75.4% (1,745/2,314) while the proportion of group B was 89.1%(3,395/3,811) showing a significant differences between the 2 groups in injury cause ( χ2=14.363, P< 0.05). Based on X-ray films or computer tomography (CT) of 3,560 patients, the Evans type II and III were the most common types. Type II accounted for the highest proportion in group A (38.1%, 239/628) while type III did in group B (39.5%, 1,159/2,932) . There were significant differences between the 2 groups in the proportion of Evans classification ( χ2=183.569, P< 0.05). Of all the 6,125 fracture cases, 4,846 fracture patients (79.1%) were complicated with medical diseases. There was a statistically significant difference between the 2 group of the patients who were complicated with medical diseases ( χ2=8.916, P< 0.05). A total of 5,148 patients were treated by operation and 1,925 patients were in group A while the other 3,259 cases were in group B. In group A, the median hospitalization was 14 days and the quartile interval was 8 days. In group B, the median hospitalization and the quartile interval was 12 days and 8 days respectively. There were significant differences between the 2 groups in length of hospital stay for patients treated by surgery ( Z=-9.909, P<0.001). Conclusion:The intertrochanteric fractures admitted to the Third Hospital of Heibei Medical University in the past 10 years were more common in females than in males. Fall and indoor activity was the most common injury cause. Evans types II and III prevailed. The fractures showed an aging trend by comparing the former 5 years and latter 5 years. The number of intertrochanteric fracture patients complicated with medical diseases increased significantly, but the total days of hospitalization was on the decline.
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Objective@#This study is to investigate the outcome of unilateral cleft lip repairment using trilobate flap and nasal-labial muscle tension system reconstruction.@*Methods@#From January 2015 to December 2017, 264 children with unilateral cleft lip were performed cheiloplasty. For all the patients, trilobate flap was adopted. The tension lines group among nasal-labial muscles were reconstructed following a three-dimensional pattern. Long-term results were evaluated using postoperative photos. Three measurements were collected, to compare the nasolabial contour on the cleft side and noncleft side.@*Results@#Six to 12 months follow-up was completed in 112 patients. Asymmetry percentage of lip height was (2.98±1.65)%, while nostril width ratio was 1.02±0.05, and nostril height ratio was 0.94±0.04. Aesthetic contour of vermillion and philtrum were satisfied.@*Conclusions@#Trilobate flap technique combined with the reconstruction of nasal-labial muscle tension system have reliable effect on unilateral cleft lip repair. With proper application, satisfactory and stable outcomes can be achieved.
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Objective@#To explore the safety and effectiveness of transthoracic endoscopic thyroid surgery in thyroid surgery.@*Methods@#Retrospectively analyzed 230 patients with thyroid tumor aged from 19 to 71 years, including 67 males and 163 females, who were admitted to General minimally invasive surgery, First Affiliated Hospital of Henan University of Chinese Medicine from March 2018 to August 2019. All patients were divided into traditional operation group (n=95) and endoscopic group (n=135) according to the operation method. The general information of the two groups of patients before surgery, including the time of surgery and tumor removal, amount of bleeding during surgery, postoperative drainage and extubation time, were compared. And the hospital stay, hoarseness, postoperative bleeding, incision infection, numbness, twitching, satisfaction and other related indicators were calculated also. SPSS 22.0 software was used for statistical analysis. Normally distributed measurement data were expressed as Mean±SD, and conparisons between groups were calculated by t test or χ2 test. The non-normally distributed data were expressed as M(P25, P75) and were analyzed by the Mann-Whitney U test.@*Results@#Compared with the preoperative general data, the number of nodules in the traditional group was 3.00 (2.00, 3.00), and the number of nodules in the endoscope group was 2.00 (1.00, 3.00). The difference was statistically significant (Z=-4.461, P<0.01). The maximum diameter of the tumor in the traditional group is 1.00 (1.00, 2.00) cm, and the maximum diameter of the tumor in the endoscope group is 1.00 (1.00, 2.00) cm. The two are statistically significant (Z=-2.041, P=0.041). There were no significant differences in age, gender, course of disease, nodule type, cystic change, nodule location, aspect ratio, nodule echo, nodular morphology, and nodular calcification (all P>0.05). Comparison of intraoperative indicators, the operation time of the traditional group was shorter than that of the endoscope group [(67.51 ± 9.27) min vs (89.86 ± 10.32) min, t=11.462, P<0.01]; the tumor removal time of the traditional group was also shorter than that of the endoscope group [( 28.37 ± 8.94) min vs (33.35 ± 7.39) min, t=5.456, P<0.01]; the blood loss in the traditional group was significantly more than that in the endoscope group [(51.34 ± 3.26) ml vs (20.65 ± 5.89) ml, t=14.723, P<0.01]. The recurrent laryngeal nerve was explored intraoperatively in both groups with a detection rate of 100%, the anesthesia was good in both groups, and the drainage tubes were indwelling in both groups. The drainage volume of the traditional group was significantly higher than that of the endoscope group [(135.76 ± 60.55) ml vs (69.12 ± 37.13) ml, t=10.805, P<0.01]. The extubation time was longer in the traditional group than in the endoscope group [(5.54 ± 1.44) d vs (4.66 ± 1.55) d, t=2.384, P=0.023]. In terms of hospitalization time, the traditional group was significantly longer than the endoscope group [(10.48 ± 5.37) d vs (7.25 ± 3.68) d, t=11.549, P<0.01]. There were 11 cases of hoarseness in the traditional group and 4 cases of hoarseness in the endoscope group, and there has statistically significant (χ2=6.790, P=0.009). There were 5 cases of postoperative bleeding in the traditional group, 1 case of postoperative bleeding in the endoscope group, the difference between the two was statistically significant (χ2=4.365, P=0.037); 5 cases of incision infection in the traditional group, none in the endoscope group, and the difference was statistically significant (P=0.012); 4 cases of numbness convulsions in the traditional group, none in the endoscope group, and there was statistical significance (P=0.028); 87 cases of satisfaction in the traditional group, and 134 cases of satisfaction in the endoscope group, and the difference was statistically significant (χ2=6.825, P=0.009).@*Conclusions@#Transthoracic endoscopic thyroid surgery has fewer complications in thyroid surgery and quicker postoperative recovery. It is worthy of widespread promotion, but the specific implementation plan needs to be further optimized.
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Objective To explore the safety and effectiveness of transthoracic endoscopic thyroid surgery in thyroid surgery.Methods Retrospectively analyzed 230 patients with thyroid tumor aged from 19 to 71 years,including 67 males and 163 females,who were admitted to General minimally invasive surgery,First Affiliated Hospital of Henan University of Chinese Medicine from March 2018 to August 2019.All patients were divided into traditional operation group (n =95) and endoscopic group (n =135) according to the operation method.The general information of the two groups of patients before surgery,including the time of surgery and tumor removal,amount of bleeding during surgery,postoperative drainage and extubation time,were compared.And the hospital stay,hoarseness,postoperative bleeding,incision infection,numbness,twitching,satisfaction and other related indicators were calculated also.SPSS 22.0 software was used for statistical analysis.Normally distributed measurement data were expressed as Mean ± SD,and conparisons between groups were calculated by t test or x2 test.The non-normally distributed data were expressed as M(P25,P75) and were analyzed by the Mann-Whitney U test.Results Compared with the preoperative general data,the number of nodules in the traditional group was 3.00 (2.00,3.00),and the number of nodules in the endoscope group was 2.00 (1.00,3.00).The difference was statistically significant (Z =-4.461,P ＜ 0.01).The maximum diameter of the tumor in the traditional group is 1.00 (1.00,2.00) cm,and the maximum diameter of the tumor in the endoscope group is 1.00 (1.00,2.00) cm.The two are statistically significant (Z =-2.041,P =0.041).There were no significant differences in age,gender,course of disease,nodule type,cystic change,nodule location,aspect ratio,nodule echo,nodular morphology,and nodular calcification (all P ＞ 0.05).Comparison of intraoperative indicators,the operation time of the traditional group was shorter than that of the endoscope group [(67.51 ± 9.27) min vs (89.86 ± 10.32) min,t =11.462,P ＜ 0.01];the tumor removal time of the traditional group was also shorter than that of the endoscope group [(28.37 ± 8.94) min vs (33.35 ± 7.39) min,t =5.456,P ＜0.01];the blood loss in the traditional group was significantly more than that in the endoscope group [(51.34 ± 3.26) ml vs (20.65 ± 5.89) ml,t =14.723,P ＜0.01].The recurrent laryngeal nerve was explored intraoperatively in both groups with a detection rate of 100％,the anesthesia was good in both groups,and the drainage tubes were indwelling in both groups.The drainage volume of the traditional group was significantly higher than that of the endoscope group [(135.76 ± 60.55) ml vs (69.12 ± 37.13) ml,t =10.805,P ＜0.01].The extubation time was longer in the traditional group than in the endoscope group [(5.54 ± 1.44) d vs (4.66 ± 1.55) d,t =2.384,P=0.023].In terms of hospitalization time,the traditional group was significantly longer than the endoscope group [(10.48 ± 5.37) d vs (7.25 ± 3.68) d,t =11.549,P ＜ 0.01].There were 11 cases of hoarseness in the traditional group and 4 cases of hoarseness in the endoscope group,and there has statistically significant (x2 =6.790,P =0.009).There were 5 cases of postoperative bleeding in the traditional group,1 case of postoperative bleeding in the endoscope group,the difference between the two was statistically significant (x2 =4.365,P =0.037);5 cases of incision infection in the traditional group,none in the endoscope group,and the difference was statistically significant (P =0.012);4 cases of numbness convulsions in the traditional group,none in the endoscope group,and there was statistical significance (P =0.028);87 cases of satisfaction in the traditional group,and 134 cases of satisfaction in the endoscope group,and the difference was statistically significant (x2 =6.825,P =0.009).Conclusions Transthoracic endoscopic thyroid surgery has fewer complications in thyroid surgery and quicker postoperative recovery.It is worthy of widespread promotion,but the specific implementation plan needs to be further optimized.
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<p><b>OBJECTIVE</b>To establish a novel method to determine specific type of amyloidosis through laser microdissection and mass spectrometry (LMD/MS) based proteomic analysis.</p><p><b>METHODS</b>There were 138 formalin-fixed and paraffin-embedded (FFPE) biopsy samples of patients who were diagnosed as systemic amyloidosis used in this study. For each case, a 10 μm section stained with congo-red and positive amyloid deposits were identified under fluorescent light, followed by micro-dissection and mass spectrometry analysis. The amyloidosis subtype was confirmed based on the most abundant amyloid protein.</p><p><b>RESULTS</b>The tissue types of 138 specimens were as following: subcutaneous abdominal fat accounted for 26%, tongue for 19%, gingiva for 11%, kidney for 9%, intestine for 9%, heart for 6% and others for 20%. Specific types of amyloid were accurately detected in 121 cases, including 106 (87.6%) amyloid light chain (AL) type, 7 (5.8%) amyloid trans-thy-retin (ATTR), 2 (1.7%) amyloidogenic protein A (AA), 2 (1.7%) amyloid heavy chain (AH)/AL+AH, 2 (1.7%) fibrinogen alpha chain (AFib), 1(0.8%) amyloid apolipoprotein A-type II (AApoA-II) and one (0.8%) amyloid lysozyme (ALys). Diagnosis of amyloidosis was excluded in 5 cases. The types of twelve cases were indeterminate by LMD/MS. On the whole, LMD/MS reached 91.3% accuracy rate in amyloid typing. Commonly involved organs (for example, heart, kidney and liver) turned out to be suitable sources of FFPE samples with typing success rate of almost 100%. In contrast, MS analysis was successful in only 83.3% of subcutaneous abdominal fat samples.</p><p><b>CONCLUSION</b>LMD/MS method provided a more direct technique for accurate typing of amyloidosis in a single procedure.</p>