Objective To compare the feasibility and safety of laparoscopic Roux-en-Y choledochojejunostomy versus open Roux-en-Y choledochojejunostomy.Methods From October 2011 to June 2013,37 patients underwent laparoscopic Roux-en-Y choledochojejunostomy (observation group) and 42 underwent open Roux-en-Y choledochojejunostomy (control group).We retrospectively compare the two groups in terms of operation time,intraoperative blood loss,length of incision,postoperative hospital stay,postoperative gastrointestinal function recovery time,incision infection rate and the incidence of biliary fistula after surgery.Results In observation group operation time was (275.43 t 12.28) min,higher than that of control group (189.12 ± 19.35) min (P =0.031),intraoperative blood loss was (83.13 ±6.34) ml,incision length (5.76 ±0.7) cm,postoperative recovery time of gastrointestinal tract of (43.33 ±3.15) h,postoperative hospital stay (12.65 ± 2.19) d,were in favor of the observation group which were respectively (180.37 ±9.67) ml,(18.51 ±1.9) cm,(70.45 ±4.97) h and (22.16 ±4.61) d (t =33.17,36.73,33.17,P ＜ 0.05).Postoperative incision infection rate in observation group was 5.4％,lower than the control group (19.07％) (chi-square =22.12,P ＜ 0.05).Between the two groups there was no significant difference in the incidence of biliary fistula.Conclusions Laparoscopic Roux-en-Y hepatojejunostomy is safe,effective,and less traumatic procedure.

Objective To investigate the effect of astilbin on expressions of perforin and granzyme B in activated T cells of mouse heart transplantation model with acute rejection.Methods Cardiomyocytes of BALB/C mouse and spleen cells of C57BL/6 mouse were harvested and made into single cell suspensions.The cardiomyocytes(2?10~5 ml~(-1))as stimulators and spleen cells(1?10~6 ml~(-1)) as responsers were mixed and cultured.The model of mouse heart transplantation with acute rejection in vitro was therefore established.There were two groups in the experiment.Control group is the mixed culture of the cardiomyocytes and spleen cells;Astilbin group is the mixed culture of the cardiomyocytes and spleen cells with astilbin(15?g/ml).Apoptosis of T cells were analyzed by TUNEL assay.The expressions of perforin and granzyme B were measured by RT-PCR.Results Apoptosis of activated T cells in Astilbin group was significantly increased than that of the control group(P

Background and purpose:Prostate-speciifc membrane antigen (PSMA), a cell surface protein with high expression in prostate carcinoma (PC) cells, is an attractive target for PC imaging and therapy. Small-molecule radiopharmaceuticals targeting PSMA can detect the location and extent of disease with high sensitivity and speciifcity. The aim of this study was to evaluate the value of technetium-99m-labelled small molecule against PSMA (HYNIC-Glu-Urea-A,99mTc-PSMA) for the detection of primary and metastatic prostate cancers.Methods:Twenty-four prostate cancer patients and 1 patient with benign prostate hyperplasia received whole-body scan followed by abdominopelvic SPECT/CT 2 h after intravenous injection of99mTc-PSMA. Tumor to muscle uptake ratio of99mTc-PSMA was calcu-lated using region of interest (ROI) technology. The sensitivity and specificity of99mTc-PSMA were evaluated. The relationships between positive99mTc-PSMA and prostate speciifc antigen (PSA) level and Gleason Score were analyzed. Results:Based on per patient, the sensitivity and speciifcity of99mTc-PSMA were 72.7% (16/22) and 100% (3/3), re-spectively. The level of PSA in patients with positive99mTc-PSMA imaging was signiifcantly higher than that in patients with negative99mTc-PSMA imaging [(PSA median 17.31 ng/mL, range: 2.26-3 239.0 ng/mL)vs(PSA median 0.49 ng/mL, range: 0.07-9.28 ng/mL)] (Z=-3.51,P<0.001). Among newly diagnosed patients and recurrent patients with PSA more than 2.0 nm/mL, it was apparent that99mTc-PSMA imaging was able to detect lesions with improved sensitivity of 94.1% (16/17). Gleason Scores between positive99mTc-PSMA patients and negative99mTc-PSMA patients were not significantly different (Z=-0.69,P=0.52).Conclusion:With the combination of whole-body scan and tomography, 99mTc-PSMA SPECT/CT can be an excellent and speciifc molecular imaging strategy to detect prostate cancer and its metastases.

Objective To study the clinical value of three-dimensional CT reconstruction model of portal venous system combined with finite element analysis to measure portal venous pressure in patients with portal hypertension.Methods A retrospective study was conducted on 27 patients who were diagnosed to have portal hypertension at the Second Affiliated Hospital of Kunming Medical University from May 2016 to May 2018.There were 17 males and 10 females,with ages ranging from 34 to 77 years (mean 56 years).All these patients underwent transjugular intrahepatic portal venous shunt (TIPS) during which the portal venous pressure was measured.The imaging data was imported into the three-dimensional software of medical imaging to reconstruct the three dimensional model of portal vein,and the finite element analysis software of ANSYS was used to calculate the portal venous pressure by calculation with given boundary conditions.Pearson correlation was used to analyze the correlation between the actual measurement of portal venous pressure and the predicted value.Results The actual measured value of portal vein pressure before TIPS in 27 patients with portal hypertension was (3 783 ±930) Pa,and the predicted value was (4 238 ± 1 218) Pa.There was no significant difference (P ＞ 0.05).The predicted value of portal venous pressure was positively correlated with the actual measured value (r =0.402,95 ％ CI:0.026-0.678,P ＜ 0.05).Conclusion Non-invasive measurement of portal venous pressure based on three-dimensional portal venous reconstruction combined with finite element analysis correlated with actual portal venous pressure in patients with portal hypertension.

Objective To elucidate the malnutrition in patients with hospital-acquired acute kidney injury(AKI), and to examine the association betweensubjective global assessment (SGA) and prognosis.Methods Adult patients with hospital-acquired AKI were prospectively enrolled in this cohort study.Nutritional evaluations, including SGA, anthropometric and serum nutritional markers were conducted at enrollment.Overall survival at 90 days among different SGA scores was analyzed using Kaplan-Meier methods, and differences were tested using the log-rank test.The Cox model was used to analyze the relationship between SGA scores and all-cause mortality after adjusting for confounders.Results A total of 170 patients were enrolled.The prevalence of moderate malnutrition(SGA B) and severe malnutrition(SGA C) was 51.8％ and 22.9％ respectively, while patients with normal nutrition(SGA A) accounted for 25.3％.After 90 days follow-up, all-cause mortality was 9.8％ in SGA A group, 34.9％ in SGA B group and 56.8％inSGACgrouprespectively. Afteradjustingforage,sex,dialysis,ventilation, hemoglobin, platelets and bilirubin, the hazard ratio(HR) of 90 days all-cause mortality was 4.0(95％ CI 1.42-11.22, P=0.008) in malnutrition group (SGA B group and SGA C group) compared with SGA A group.The Kaplan-Meier curve also revealed that the worse the SGA score was, the lower the cumulative survival became (P＜0.01).Conclusion SGA score is an independent risk factor for all-cause mortality within 90 days in patients with hospital-acquired acute kidney injury.

Objective To study the impact of surgical teamwork in totally laparoscopic splenectomy and pericardial devascularization (LSPD) in the treatment of portal hypertension,and advice on technical hints.Methods A retrospective study was conducted on the clinical features of eighty-four patients who underwent totally laparoscopic splenectomy and pericardial devascularization in the Second Affiliated Hospital of Kun Ming Medical University from January,2014 to December,2017.Results Totally laparoscopic procedures were performed successfully in 80 patients.The procedure was converted to hand-assisted laparoscopic splenectomy and pericardial devascularization in 3 patients because of uncontrollable bleeding.One patient who initially underwent laparoscopic cholecystectomy developed an intraoperative blood loss of 1 500 ml.The surgery was terminated and was continued one week later after stabilization of the patient.Of the 80 patients who underwent totally LSPD,the operation time ranged from 116.0 to 243.0 (146.0 ± 33.0) min.The intraoperative blood loss ranged from 60.0 to 600.0 (214.0 ± 31.0) ml.Routine coagulation function and portal vein color Doppler ultrasound examination carried out within 3 months after surgery detected postoperative portal vein thrombosis in four patients.They responded successfully to antiplatelet and anticoagulant therapy.There were no perioperative deaths,variceal bleeding,gastrointestinal fistula and infection.Conclusions With proper surgical steps and skilled laparoscopic technique carried out by an experienced team of surgeons,totally laparoscopic splenectomy and pericardial devascularization was safe and effective in treating portal hypertension.Strict perioperative management provided a guarantee for the safe operation.

Objective To investigate the effect of acupuncture on cholinergic anti-inflammatory pathway in the hippocampus of aged rats during global cerebral ischemia-reperfusion ( I∕R ) . Methods Ninety-six clean-grade healthy male Sprague-Dawley rats, aged 17-22 months, weighing 440-580 g, were divided into 3 groups ( n=32 each) using a random number table method: sham operation group ( group S), global cerebral I∕R group (group I∕R) and acupuncture group (group AP). Global cerebral I∕R was induced by 4-vessel occlusion method described by Pulsinelli in group I∕R and group AP. Baihui and Feng-chi were stimulated for 14 consecutive days before ischemia in group AP. Four rats were sacrificed at 1, 3, 5 and 7 days of reperfusion, and brains were removed for determination of neuronal apoptosis by TUNEL. Four rats were sacrificed at 1, 3, 5 and 7 days of reperfusion, and brains were removed for determination of the expression of α7 nicotinic acetylcholine receptor (α7nAChR), choline acetyltransferase (ChAT), tumor necrosis factor-α ( TNF-α) and interleukin-1β ( IL-1β) in the hippocampal CA1 region by Western blot. The apoptosis rate was calculated. Results Compared with group S, the apoptosis rate of hippocam-pal neurons was significantly increased, and the expression of α7nAChR, ChAT, TNF-α and IL-1β was up-regulated at each time point of reperfusion in I∕R and AP groups ( P<0. 05) . Compared with group I∕R, the apoptosis rate of hippocampal neurons was significantly decreased, the expression of α7nAChR and ChAT was up-regulated, and the expression of TNF-α and IL-1β was down-regulated at each time point ofreperfusion in group AP (P<0. 05). Conclusion The mechanism by which acupuncture mitigates global cerebral I∕R injury may be related to activating cholinergic anti-inflammatory pathway in the hippocampus of aged rats.

Objective: To investigate the short-term efficacy and adverse events of chemotherapy combined with androgen-deprivation therapy in high-volume metastatic hormone sensitive prostate cancer. Methods: From March 2015 to August 2017, 55 patients with high-volume metastatic hormone sensitive prostate cancer were enrolled at Department of Urology, Fudan University Shanghai Cancer Center receiving chemotherapy combined with androgen-deprivation therapy. The age was 65(8) years (M(Q_R)) (range: 46 to 79 years). Patients were enrolled in the study for continuous androgen-deprivation therapy (medical or surgical castration), combined with docetaxel 75 mg/m² intravenous injection on the first day, repeated every 21 days (6 cycles). Endpoints included overall survival, progression-free survival of prostate cancer, prostate specific antigen (PSA) response rate, and adverse events. Results: The follow-up time was 21.2(11.7) months. The PSA value before chemotherapy was 144.9(415.3) μg/L. The days in patients undergoing androgen deprivation therapy before chemotherapy was 14(23) days. Four patients (7.3%) presented 0 in Eastern Cooperative Oncology Group scoring system and 51 patients(92.7%) presented 1. Thirty-nine patients (70.9%) completed more than 6 cycles of combined chemotherapy, 17 patients (30.9%) showed PSA<0.2 μg/L at 6 months after treatment, and 14 patients (25.5%) showed PSA<0.2 μg/L at 12 months after treatment. Twenty-eight patients (50.9%) had grade 3 to 4 neutropenia and 1 patient (1.8%) developed infectious neutropenia and died. Nausea and vomit occurred in 16 patients (29.1%). Twelve patients (21.8%) underwent dose adjustment due to adverse events in blood system. Conclusions The short-term effect was confirmed in high-volume metastatic hormone sensitive prostate cancer using chemotherapy combined androgen-deprivation therapy, and the long-term effect remains to be seen. Myelosuppression during chemotherapy requires close attention, and taking timely examination is recommended.

Objective:To compare the efficacy and safety of robotic surgery and open surgery in the treatment of hilar cholangiocarcinoma.Methods:PubMed, Embase, Cochrane Library, Web of Science, CNKI and Wanfang database were searched to compare the treatment of hilar cholangiocarcinoma by robotic surgery and traditional open surgery. Literatures were searched from the establishment of the database to July 2023. Compare operation time, intraoperative blood transfusion rate, R 0 resection rate, lymph node metastasis rate, postoperative complication rate and hospital stays between the two groups. The combined odds ratio ( OR) and mean difference ( MD) and 95% confidence interval (95% CI) were calculated using RevMan 5.4 software. Results:A total of 4 studies were included, including 267 patients with hilar cholangiocarcinoma. There were 177 males and 90 females, aged (58.8±5.7) years. A total of 267 patients were divided into open surgery group ( n=165) and robotic surgery group ( n=102) according to the surgical formula. The extract results show: operative time ( MD=-103.96, 95% CI: -216.90-8.98, P=0.070) and intraoperative blood transfusion rate ( OR=1.32, 95% CI: 0.43-4.07, P=0.630), R 0 resection rate ( OR=1.41, 95% CI: 0.71-2.81, P=0.330), lymph node metastasis rate ( OR=1.62, 95% CI: 0.46-5.63, P=0.450), postoperative complications ( OR=0.60, 95% CI: 0.28-1.31, P=0.200), and postoperative hospital stay ( MD=2.17, 95% CI: -11.56-15.90, P=0.760). Conclusion:In the treatment of hilar cholangiocarcinoma, robotic surgery is as safe and feasible as open surgery. However, due to the limited number and quality of included studies, the above conclusions need to be verified by more high-quality studies.

Objective:To study the use of double gastric hanging in laparoscopic spleen-preserving distal pancreatectomy.Methods:A retrospective analysis was conducted on the clinical data of 74 patients who underwent laparoscopic spleen-preserving distal pancreatectomy at the Second Affiliated Hospital of Kunming Medical University from January 2016 to December 2018. There were 23 males and 51 females, with age ranging from 26 to 69 years (average 46.7 years). The patients were divided into the suspension group ( n=39) and the control group ( n=35) according to whether the gastric double suspension technique was used during the operation. The gastric body and gastric pylorus in the suspension group were suspended by self-made rubber slings. These rubber slings were not used in the control group. The operative time, intraoperative blood loss, blood transfusion, tumor diameter, length of resected pancreas, postoperative pancreatic fistula grade B/C, postoperative bleeding and postoperative hospital stay were compared between the two groups. Results:There were no significant differences between the two groups in gender, age, body mass index, operation time, blood transfusion rates, length of resected pancreas, and postoperative pancreatic fistula grade B/C (all P>0.05). The tumor diameter of the suspension group was (3.7±0.8) cm, which was significantly longer than that of the control group (2.5±0.6) cm. The intraoperative blood loss was (130±20) ml, and the postoperative hospital stay was (8±3) d, which were significantly less than those in the control group (250±20) ml, (16±5) d (all P<0.05). Conclusion:The use of gastric double suspension technique in laparoscopic spleen-preserving pancreatic tail resection resulted in significantly reduced intraoperative blood loss and postoperative hospital stay.