Objective To evaluate the safety, feasibility and other potential advantages of laparoendoscopic single-site surgery (LESS) compared to conventional laparoscopic surgery (CLS) for tubal pregnancy. Methods We manually searched Pubmed, the Cochrane Library, web of science, CNKI and China Biology Medicine for the relevant references about comparison of single-port laparoscopic salpingectomy with multi-port laparoscopic salpingectomy in the treatment of tubal pregnancy. The quality of the studies was evaluated, then meta-analysis was conducted using RevMan 5.3 software. Result Eventually, 2 RCTS and 14 retrospective studies including a total of 1541 cases were identi昀ed. The results of the meta-analysis for LESS versus CLS were as follows: a longer operative time [WMD=8.54, 95%CI (2.43, 14.64), P = 0.006], no significant differences in terms of total complications [OR= 0.68, 95%CI (0.27,1.71), P = 0.410]/operative blood loss [WMD = -0.01, 95%CI (-2.51,2.48), P = 0.990]/gastrointestinal function recovery time [WMD = -0.45, 95%CI (-1.72,0.82), P = 0.490], but shorter hospital stay [WMD=-0.40, 95% (-0.75, -0.06), P = 0.020], less postoperative analgesic treatment [OR= 0.38, 95%CI (0.22,0.67), P = 0.000]. Conclusions LESS for surgical treatment of tubal pregnancy is safe and feasible with shorter hospitalstay, less postoperative pain. LESS may therefore be a feasible alternative of CLS in the surgical approach of tubal pregnancy.

Objective To investigate the value of serum concentration of VEGF-C in the prognosis of advanced pancreatic cancer. Methods Thirty-five patients with advanced pancreatic cancer were selected from Aug. 2006 to Feb. 2008, ELISA method was used to detect the serum level of VEGF-C, CA19-9 and KPS score was calculated, and survival was analyzed by Kaplan Meier method. The survival difference was calculated by log rank. Cox regression model was used to perform univariate and multivariate analysis. Results The mean serum concentration of VEGF-C was ( 1309 ± 542 ) pg/ml in patients with advanced pancreatic cancer, which were significantly higher than that those in normal control [ (278 ±115) pg/ml, P <0.01 ]. In Cox regression, KPS score, serum CA19-9 and VEGF-C were independent factors (x2 =7.208, 6.908, 3.867, P = 0.007, 0.009, 0.049). In multivariate analysis, serum VEGF-C and KPS score were independent factors (x2 =4.873, P=0.027, x2 =5.274, P =0.022). Using serum concentration of VEGF-C at 1280 pg/ml as the cut-off point, the mean survival of patients with VEGF-C ≤1280 pg/ml was 10.0 months, and the median survival was 11.3 months, 1 year cumulative survival was 50.0% ; while they were 6.0 months, 6.3 months and 5.9% in patients with VEGF-C > 1280 pg/ml, and the difference was statistically significant (x2 = 9.400, P= 0.002). Using KPS score 70 as the cut-off point, the mean survival of patients with KPS <70was 6.0 months, and the median survival was 6.6 months, 1 year cumulative survival was 21.4% ; while they were 9.0 months, 10.1 months, 33.3% in patients with KPS score ≥70,and the difference was statistically significant (x2 =4.040, P =0.044). The difference of the median survival, 1 year cumulative survival in patients with CA19-9 ≤200 U/ml or >200 U/ml was not statistically significant (10.0 months vs. 7.8 months, 37.5% vs. 21.1% ; x2 =1910, P=0. 167). Conclusions Serum concentration of VEGF-C can used as an independent factor for predication of prognosis of patients with advanced pancreatic cancer.

Objective To evaluate arch replacement in islet fashion combined with intraluminal-including technique.Methods From Aug.2011 to Mar.2012,19 patients with type A aortic dissection needed arch replacement were selected,whose cephalo-brachial artery and left common carotid artery were intact or left subclavicular artery alone was involved,Sixteen patients were male.Mean age was (49.6 ± 5.7) years.Urgent surgery and red surgery were completed in 13 cases,6 cases and 1 case,respectively.The arch replacement was performed in a modified islet fashion,remaining the adventitia and trimming intima,constituting a common opening with the proximate end of stented elephant trunk in side-to-side manner by using intraluminal anastomosis technique.This common opening was anastomosed with the distal end of the ascending aortic Dacron graft,completed the procedure of arch replacement.If left subclavicular artery was involved by dissection or it was displaced pathologically as to expose difficultly,it should be covered by the stented elephant trunk,and be transplanted to left common carotid artery in end-to-side manner.Finally,the entire Dacron graft was wrapped by remained adventitial coat using including technique,with a shunt connecting to right atrium.Results Mean duration of cardiac pulmonary bypass,aortic cross clamp and selective cerebral perfusion was (215 ±54),(93 ± 18) and (30 ±6) minutes,respectively.In one case with delayed sternum closure due to extensive bleeding,the mean chest tube output in first 24 hours was (926 ±322) mL,the mean duration of postoperative ICU was (78 ±21) hours; none of the patients was reopened for bleeding.Postoperative hypoxemia,transient neurologic dysfunction,and hematosepsis occurred in 3 cases,1 case and 1 case,respectively.One patient needed re-intubation attributing to pulmonary infection.There was no complication of permanent neurologic deficit or postoperative visceral mal-perfusion.All patients survived and were discharged from hospital.Severe complication was not observed at follow-up of 1 to 5 months.Conclusions The modified aortic arch replacement procedure,which adopt islet fashion combined with intraluminal inclusion technique,characterized by its feasibility,safety,reproduction and easy to control bleeding,may be considered as an alternative approach for managing arch disease.Its short-term outcomes were competitive and prospective was promising.

BACKGROUND:Persistent hyperglycemia has been identified as promoting neurovascular dysfunction,leading to irreversible endothelial dysfunction,increased neuronal apoptosis,oxidative stress and inflammation.These changes in combination or alone lead to microvascular and macrovascular lesions as well as progressive neuropathy.Noncoding RNAs may provide a new strategy for understanding the etiology,pathogenesis and treatment of the disease. OBJECTIVE:To review the role and mechanism of noncoding RNAs in the occurrence and development of diabetic peripheral neuropathy by reviewing relevant literature at home and abroad,in order to provide new ideas and approaches for noncoding RNAs in the prevention,diagnosis and treatment of diabetes neuropathy. METHODS:CNKI and PubMed were retrieved for relevant literature published from database inception to 2022.The key words were"noncoding RNA;lncRNA;miRNA;diabetes peripheral neuropathy;expression profile"in Chinese and English,respectively.The retrieved documents were summarized and analyzed,and 61 articles were finally selected for further review. RESULTS AND CONCLUSION:(1)Noncoding RNA plays a key role in the pathophysiological process of diabetic peripheral neuropathy.Among the most widely studied regulatory noncoding RNA species,there are long noncoding RNAs,circular RNAs and microRNAs.(2)Through the regulation of noncoding RNAs,the activation or inhibition of related cell pathways,inflammatory genes and downstream-related cytokines will inhibit cell apoptosis,improve inflammation,and thus change the expression of target genes to participate in the process of diabetic neuralgia.(3)Although many microRNAs and long noncoding RNAs have been found to participate in diabetic peripheral neuropathy,the mechanisms of many noncoding RNAs are unclear,and the same noncoding RNAs may play different roles in different modes.Therefore,it is necessary to further study their action modes in disease etiology and pathology,thereby clarifying their role in the pathogenesis of diabetic peripheral neuropathy.However,the criteria for evaluating noncoding RNA activity have not yet been established,and further research is needed on which specific noncoding RNAs play a dominant regulatory role.(4)MicroRNAs,long noncoding RNAs and their target genes can regulate progressive neuropathy,which are expected to become new targets for the clinical prevention and treatment of diabetic peripheral neuropathy and new biomarkers for the development and prognosis of diabetic peripheral neuropathy.

Objective To summarize the application of double valve ring enlargement combined with mitral Chimney technique (Chimney Commando) in the secondary valve replacement and to analyze the efficacy in the near and medium term. Methods Patients who underwent the secondary aortic valve and mitral valve (double valve) replacement by Chimney Commando in Wuhan Asia Heart Hospital from 2019 to 2022 were included, and their clinical data were retrospectively collected to analyze the safety and feasibility of this procedure in secondary valve replacement of small aortic root patients. Results A total of 49 patients (44 females and 5 males) were included. The body surface area was 1.64±0.17 m2. The time from the first operation was 13.10±5.90 years. Except for 4 patients whose first operation was valvuloplasty, the remaining 45 patients were all patients after valve replacement, 41 patients of double valves replacement, including 39 patients with mechanical valve and 2 patients with biological valve. The majority of the aortic valves were St.Jude regent 19 mm or St.Jude regent 21 mm, accounting for 30.61% and 34.69%, respectively. The mitral valves were predominantly St.Jude 25 mm mechanical valves, making up 65.31%. All patients underwent Chimney Commando double valve ring enlargement, and the mean time of aortic occlusion was 154.00±45.40 min. The mean size of the aortic valve was 23.90±1.40 mm and that of the mitral valve was 28.20±1.20 mm, and the transvalvular pressure difference across the aortic valve was 20.16±5.76 mm Hg at 6 months postoperatively. There was one death during hospitalization due to multi-organ failure. The follow-up time ranged from 1 to 24 months with a median time of 8 months. Two patients were implanted with permanent pacemakers during the follow-up period and 1 patient died due to massive stroke and malignant arrhythmia. Conclusion Chimney Commando is safe and effective in patients with secondary double valve replacement, and the postoperative prosthetic valves have good hemodynamics, and can achieve good clinical results in the near and medium term.