Objective To study the safety and feasibility of laparoscopic total splenectomy (LTS) and laparoscopic partial splenectomy (LPS) in the diagnosis and treatment of benign splenic tumors by comparing the perioperative and follow-up data between these two operative approaches.Methods We retrospectively analyzed the clinical data of 57 patients who underwent laparoscopic surgery for benign splenic tumors from December 2009 to April 2016.These patients were divided into the LTS and the LPS groups.The clinical data including the preoperative,intraoperative,postoperative and follow-up data were analyzed.Results When compared with the LPS group,the LTS group had shorter operation time [(97.0 ± 22.1)min vs.(135.0 ± 24.6) min,P ＜ 0.05] and less blood loss [(33.3 ± 19.5) min vs.(90.6 ± 55.1)min,P ＜ 0.05],but there were no significant differences between the two groups in the length of hospital stay,the duration of drainage tube placement,the amount of postoperative analgesics as well as the incidences of pulmonary infection,postoperative pancreatic fistula and other complications after surgery.These incidences were low in the two groups.Conclusion Laparoscopic surgery,including LTS and LPS,were safe and feasible in treating benign splenic tumors.

Objective To investigate the effects of 3-N-butylphthalide ( NBP ) pretreatment on the score of neurological deficit , oxidative stress and pathomorphology in rats with cerebral ischemia reperfusion injury ( CIRI ) . Methods Ninety male SD rats were randomly divided into sham operation group ( Sham group ) , model group ( IR group), NBP pretreatment low dose group (NBPⅠgroup), NBP pretreatment middle dose group(NBPⅡgroup) and NBP pretreatment high dose group(NBPⅢgroup), 18 rats per group.Pretreatment was given once a day within 1 week before establishing the model of cerebral ischemia reperfusion injury .The model of middle cerebral artery occlusion ( MCAO) was subjected by suture method .The score of neurological deficit was executed after ischemia for 2h and reperfusion for 24h in all the rats.The cerebral infarction was observed by TTC staining .The pathologic change of brain was observed by HE staining under the microscope .Hydroxylamine method was used to detect activity of SOD , chemical colorimetry method was used to measure activity of GSH-PX, and TBA method was used to detect content of MDA .Results (1) In Sham group, the score of neurological deficit and the percentage of infarction volume were zero , the morphology of nerve cell was regular , and activity of SOD, GSH-PX and content of MDA of brain tissue were normal .(2) Compared with IR group , the score of neurological deficit was significantly reduced in NBP pretreatment groups (all P<0.01); the score of neurological deficit was decreased progressively in turn in NBP Ⅰ,Ⅱ,Ⅲgroup (all P<0.05).(3) Compared with IR group, the percentage of infarction volume was cut down progressively in turn in NBPⅠ,Ⅱ,Ⅲgroup (all P<0.05), and neuron injury was also induced obviously in NBP pretreatment groups .(4) Activity of SOD, GSH-PX was largely increased , and content of MDA was greatly decreased in NBP pretreatment groups ( P<0.01 ) .Activity of SOD , GSH-PX went up progressively in turn , and contents of MDA were cut down progressively in turn in NBP Ⅰ,Ⅱ,Ⅲgroup ( all P<0.05 ) .Conclusion 3-N-butylphthalide can significantly up-regulate the activity of SOD and GSH-PX, decrease the content of MDA , reduce the percentage of infarction volume , and relieve the damage of nerve cell to preventively protect the rats with cerebral ischemia reperfusion injury .

Objective To evaluate a repair approach to major defects of chest wall caused by recurrent lesion or radiation ulcer after radical mastectomy.Methods The delto-pectoral island flaps were applied to repair major defects of chest wall.The blood supply of the flap was from the 2nd and 3rd anterior perforator of the internal mammary artery.4 patients with defects of chest wall caused by recurrent cancer lesion and 8 patients caused by radiation ulcer received the pedicled flap after resection of lesion or ulcer.Results All the 12 flaps survived,in which flap necrosis at the distal end occurred in 1 case and it was cured after changing dress.After a follow-up of 6 monthls to 4 years,the flap healed and the cosmetic effect was satisfactory.Conclusions This method is an ideal method for repair of stage I major defects of chest wall caused by recurrent lesion and radiation ulcer after radical mastectomy.

Objective To investigate the safety of the laparoscopic pancreaticoduodenectomy (LPD) in 70 years of age or older patients.Methods The retrospective cohort study was conducted.The clinicopathological data of 40 patients (age ≥70 years old) who underwent pancreaticoduodenectomy in the West China Hospital of Sichuan University between January 2012 and December 2016 were collected.Twenty patients undergoing LPD were allocated into the LPD group,and 20 receiving open pancreaticoduodenectomy (OPD) who were selected by random number table during the same period were allocated into the OPD group.Observation indicators included:(1) intraoperative situations;(2) postoperative situations;(3) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect the patients' survival after discharge and tumor recurrence and metastasis up to March 2017.Measurement data with normal distribution was represented as x±s,and comparison between groups were evaluated with the t test.Measurement data with skewed distribution were described as median (range) and comparison between groups was analyzed using the nonparametric test.Comparison of count data was analyzed using the chi-square test.Comparison of ranked data was analyzed by non parametric test.Results (1) Intraoperative situations:1 patient in the LPD group was converted to open surgery,with a conversive rate of 5.0％ (1/20).Operative time and volume of intraoperative blood loss were (463 ± 10) minutes,210.5 mL (152.5-300.0 mL) in the LPD group and (332± 25) minutes,420.0 mL (350.1-493.8 mL) in the OPD group,showing statistically significant differences between the 2 groups (t =5.48,Z =-3.98,P＜0.05).Cases with intraoperative blood transfusion and pylorus preservation were respectively 4,14 in the LPD group and 6,10 in the OPD group,showing no statistically significant difference between the 2 groups (x2=0.53,1.67,P＞0.05).The results of intraoperative rapid frozen pathological examination showed negative margin of the 40 patients.(2) Postoperative situations:cases in ICU,cases with postoperative analgesia,time for out-of-bed activity,time to anal exsufflation and time for intake were 17,7,(2.2±0.7)days,(4.2± 0.9)days,(4.8±0.7)days in the LPD group and 6,15,(3.6±0.8)days,(5.7±0.9)days,(7.1 ± 2.7)days in the OPD group,showing statistically significant differences between the 2 groups (x2 =12.34,6.47,t=-6.18,-6.55,-3.65,P＜0.05).Pancreatic fistula,delayed gastric emptying (Grade B),postoperative bleeding (Grade B),biliary fistula,pulmonary infection,intestinal obstruction,wound infection,reoperation and major complication were respectively detected in 2,3,1,1,3,1,0,2,3 patients of the LPD group and 2,4,1,1,4,1,2,3,4 in patients of the OPD group,showing no statistically significant difference between the 2 groups (x2 =0.00,0.17,0.00,0.00,0.17,0.00,2.11,0.23,0.17,P＞0.05).Results of postoperative pathological examination showed that duodenal adenocarcinoma,ampullary carcinoma,lower bile duct carcinoma,pancreatic ductal adenocarcinoma and pancreatic cystic tumor were respectively detected in 8,2,5,3,2 patients of the LPD group and 10,2,4,2,2 patients of the OPD group,showing no statistically significant difference between the 2 groups (x2 =0.53,P＞0.05).Duration of postoperative hospital stay in the LPD and OPD groups were (19± 13) days and (15±7) days,respectively,showing no statistically significant difference between the 2 groups (t =1.28,P＞ 0.05).Results of postoperative oncology showed that tumor diameter,number of lymph node dissected,number of positive lymph nodes,cases with negative margin,cases in T1N0M0,T2N0M0,T3N0M0,T3N1M0,T4N0M0,T4N1M0 of TNM staging were respectively (2.4±0.7)cm,15.4±2.3,2,20,2,7,8,2,1,0 in the LPD group and (2.8±0.9)cm,14.4±2.5,3,20,1,8,5,2,3,1 in the OPD group,with no statistically significant difference between the 2 groups (t =-1.64,1.32,x2 =0.23,0.00,Z =-0.69,P＞ 0.05).(3) Follow-up situation:1 patient died respectively in both groups within the postoperative 30 days.Thirty-eight patients were followed up for 1-26 months,with a median time of 14 months.During follow-up,2 patients had tumor recurrence and 1 died of myocardial infarction in the LPD group;3 had tumor recurrence and 1 died of tumor recurrence in the OPD group.Conclusion LPD in 70 years of age or older patients is not only safe and feasible,but also significantly reduce volume of intraoperative blood loss and demand of analgesia,as well as quickly resume normal diet and activities.

Objective To explore the mechanism of Jiawei Bazhen Yimu Capsule on premature ovarian failure rats from the perspective of metabolomics.Methods Female SD rats were randomly divided into sham operation group,model group and Jiawei Bazhen Yimu Capsule low,medium and high dose groups,with 10 rats in each group.The model of premature ovarian failure was replicated by removing bilateral ovaries of rats and administered intragastrically once a day for 21 days.The serum samples of rats in each group were analyzed by ultra-high performance liquid chromatography-quadrupole-time of flight tandem mass spectrometry(UPLC-Q-TOF-MS).Combined with multivariate statistical analysis,the effects of Jiawei Bazhen Yimu Capsule on differential metabolites in rats with premature ovarian failure were investigated.The differential metabolites identified by MELIN database or KEGG database were imported into Metaboanalyst 5.0 online platform for metabolic pathway analysis.Results A total of 18 potential differential metabolites were screened and identified.Most of the differential metabolites showed a good callback trend after intragastric administration of Jiawei Bazhen Yimu Capsule.These 18 differential metabolites were enriched into 2 metabolic pathways(Pathway Impact>0.1),which were glycerophospholipid metabolism and arachidonic acid metabolism pathways.Conclusion The therapeutic effect of Jiawei Bazhen Yimu Capsule on premature ovarian failure may be related to improving the level of differential metabolites in serum and restoring normal metabolic activities in rats.

Objective To explore dynamic characteristics of the gait for the elderly with different fall risks before and after obstacle crossing. Methods Twenty-seven elderly people in community were graded as fall risk by using the time up and go test and five-time sit to stand test. The plantar pressure parameters of the elderly before and after obstacle crossing were measured and analyzed by foot pressure measurement system. Results There was no significant difference in the characteristic value of bimodal curve of overall plantar pressure between the high and low fall risk groups before and after obstacle crossing(P>0.05). The center of pressure (COP) trajectory in X direction of high fall risk group after obstacle crossing was significantly greater than that of low fall risk group (P<0.05). Before obstacle crossing, the peak pressure of the 3rd metatarsal of supporting foot was higher in high fall risk group than that in low fall risk group (P<0.05). After obstacle crossing, the peak pressure of the 1st phalanx of supporting foot was significantly lower than that in high fall risk group (P<0.05), while the lateral heel impulse in high fall risk group was significantly larger than that in low fall risk group (P<0.05).The distribution patterns of contact area of the foot for the elderly in two groups before and after obstacle crossing were basically the same, and there was no significant difference in contact area of each plantar region (P>0.05). Conclusions The support time of the elderly with high fall risk is longer than that of the elderly with low fall risk during obstacle crossing, the peak pressure of plantar metatarsal region of the crossing leg increases, and the plantar COP curve shows asymmetry, with an increase in transverse range of the coronal plane. In clinical evaluation, plantar pressure characteristics of people with fall risks during obstacle crossing should be focused on.

ObjectiveTo investigate the effect of Jiawei Bazhen Yimu capsule on serum sex hormones， sexual organs and estrogen signaling pathway in female rats with premature ovarian failure. MethodThe key target proteins of Jiawei Bazhen Yimu capsule in the treatment of premature ovarian failure were screened out by network pharmacology analysis. Female healthy SD rats were selected, and the rat model of premature ovarian failure was established by ovariectomy. Fifty ovariectomized rats were randomly divided into a model group, an estradiol (E₂) valerate group, and Jiawei Bazhen Yimu capsule low, medium, and high-dose groups. Another 10 healthy female rats were set as a sham operation group. The sham operation group and the model group were given distilled water by gavage, and other administration groups were given corresponding doses of drugs by gavage. After 21 d, the serum hormone levels of female rats were measured, including E₂, progesterone (P), follicle stimulating hormone (FSH), and luteinizing hormone (LH). Immunofluorescence staining (IF) was used to detect the protein expression levels of estrogen receptor 1 (ESR1), estrogen metabolism P4503A4 enzyme (CYP3A4), and P45019A1 enzyme (CYP19A1) in the uterine tissues of female rats. ResultAs compared with the model group, the serum E₂ and P levels of female rats in the Jiawei Bazhen Yimu capsule low, medium, and high-dose groups were significantly increased. Jiawei Bazhen Yimu capsule improved the endometrial status of female rats and increased positive expression of ESR1, CYP3A4, and CYP19A1 in the uterine tissues of female rats (P<0.05). ConclusionThe mechanism of Jiawei Bazhenyimu capsule in the treatment of premature ovarian failure may be related to its hormone-like effect and activation of the estrogen signaling pathway.