Objective:To investigate the application value of fluorescence imaging in single-port thoracoscopic anatomic segmentectomy.Methods:The clinical data of 280 patients (145 patients with fluorescence method and 135 patients with modified inflation-deflation method) who underwent thoracoscopic anatomic segmentectomy were retrospectively studied in the Anhui Chest Hospital from June 2020 to June 2021. There were 113 patients in the simple segmentectomy group and 167 patients in the complex segmentectomy group. The baseline data of the fluorescence method and the modified inflation-deflation method in the complex segmentectomy group were corrected by propensity score matching, and the perioperative results were compared between the groups.Results:There were no significant differences in segmental resection time, intraoperative blood loss, postoperative drainage, postoperative pain, postoperative extubation time, length of hospital stay, incidence of complications and cost of hand-holding between the fluorescence method and the modified method of the simple segmentectomy group.In the complex segmentectomy group, the time of segmental resection with the fluorescence method was significantly shorter than that with the modified inflation-deflation method( P<0.05), and other indexes had no significant difference. Conclusion:Fluorescence method single-port thoracoscopic anatomic segmentectomy has the same perioperative safety and short-term efficacy as modified inflation-deflation method, which can significantly shorten the operative time and improve the operative efficiency in complex anatomic segmentectomy.

Objective: To analyze the clinical characteristics of early organ injury in elderly patients with severe burns and the effects on the prognosis of patients. Methods: From January 2010 to August 2018, 62 patients with severe burns (43 men and 19 women, aged from 60 to 89 years at the time of admission) who were hospitalized in the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University, hereinafter referred to as the author′s affiliation), meeting the inclusion criteria, were included in elderly (E) group, and 124 patients with severe burns (86 men and 38 women, aged from 18 to 59 years at the time of admission) at the same term were included in young and middle-aged (YM) group. Treatment of patients in the 2 groups followed the conventional procedures of the author′s affiliation. The following data of patients in the 2 groups were retrospectively analyzed. (1) Fluid replacement volume and urine volume within the first and second post injury hour (PIH) 24 were recorded. The levels of hemoglobin, haematocrit, and blood lactic acid at admission, PIH 24 and 48 were recorded. (2) The creatine kinase isozyme-MB (CK-MB), total bilirubin, blood creatinine, oxygenation index, and blood platelet count at admission, at shock stage, and on post injury day (PID) 3 to 7 were collected. (3) The days of seriously or critically ill and deaths were recorded. Data were processed with chi-square test, group t test, Mann-Whitney U test, analysis of variance for repeated measurement, and Bonferroni correction. Results: (1) There were no statistically significant differences in fluid replacement volume within the first and second PIH 24, and urine volume within the second PIH 24 between patients in the 2 groups (t=0.351, 1.307, 1.110, P>0.05). The urine volume of patients in group E within the first PIH 24 was significantly less than that in group YM (t=5.628, P<0.05). There were no statistically significant differences in levels of hemoglobin (t=0.011, 1.075, 0.239), haematocrit (t=0, 0.033, 0.199), and blood lactic acid (t=0.017, 1.002, 0.739) at admission, PIH 24 and 48 between patients in the 2 groups (P>0.05). (2) There were no statistically significant differences in levels of CK-MB at admission and on PID 3 to 7 between patients in the 2 groups (t=0.069, 0.001, P>0.05). The level of CK-MB of patients in group E at shock stage was significantly higher than that in group YM (t=4.017, P<0.05). There were no statistically significant differences in levels of total bilirubin at admission and on PID 3 to 7 between patients in the 2 groups (t=0.227, 0.002, P>0.05). However, the level of total bilirubin of patients in group E at shock stage was significantly higher than that in group YM (t=6.485, P<0.05). The levels of blood creatinine of patients in group E at admission and shock stage were significantly higher than those in group YM (t=4.226, 12.299, P<0.05 or P<0.01), while there was no statistically significant difference between them on PID 3 to 7 (t=0.693, P>0.05). The oxygenation indexes of patients in group E at admission and shock stage and on PID 3 to 7 [(371±16), (263±16), and (228±18) mmHg (1 mmHg=0.133 kPa)] were lower than (420±13), (327±13), and (281±17) mmHg of patients in group YM, respectively (t=5.650, 9.782, 4.856, P<0.05 or P<0.01). There were no statistically significant differences in levels of blood platelet count at admission and shock stage between patients in the 2 groups (t=0.038, 0.588, P>0.05), while the level of blood platelet count of patients in group E on PID 3 to 7 was significantly lower than that in group YM (t=6.636, P<0.05). (3) The days of seriously or critically ill and death rate of patients in group E were respectively longer or higher than those in group YM (Z=-2.303, χ²=13.676, P<0.05 or P<0.01). Conclusions In the case of the same tissue perfusion at shock stage, injuries in heart, liver, kidney, lung, and coagulation system in elderly patients with severe burns are more obvious than those in young and middle-aged patients, with more severe illness and higher mortality.

OBJECTIVETo explore the feasibility, safety, and preliminary technical experience of single incision plus one port laparoscopic total gastrectomy combined with π-shaped esophagojejunal anastomosis (SILT-π) in the surgical treatment of gastric cancer.

METHODSClinical data of 5 gastric cancer patients undergoing SILT-π operation at the Department of General Surgery, The Second Affiliated Hospital of the Army Medical University from August to October 2017 were retrospectively analyzed. A 2.5-3.0 cm incision around the umbilicus was made for placing the gloveport as the passage for the lens, and the instruments of the surgeon and the assistant. Another operative port was placed in the left upper quadrant with a 12-mm Trocar for the passage of the energy device, the endoscopic cutting closure, as well as the postoperative drainage tube. A D2 lymph node (LNs) dissection was regularly conducted. After the abdominal esophagus was routinely mobilized, a side-to-side esophagus-jejunum anastomosis was made through a gastric pre-pulling esophagojejunal π-shaped anastomosis. The transection was then performed with a ligation on the cardia (or esophagus above the upper margin of the tumor) using a sterilized hemp rope in order to better expose the abdominal esophagus. Throughout the course of reconstruction, the ligature rope was held by the assistant to hold down the esophagus to allow easier esophagojejunal anastomosis. A hole was then made on the posterior wall of the esophagus, between 2 cm and 3 cm above the ligature rope, and another hole was made at the anti-mesenteric border of the jejunum 40 cm distal to the Treitz ligament. A side-to-side esophagojejunal π-shaped anastomosis was performed through two holes. An entry hole was formed after the anastomosis. After checking the anastomosis, this entry hole was closed through an intestinal mesenteric hole pre-made on its opposite side. The resected esophagus and stomach, together with the afferent loop jejunum, were simultaneously transected above the level of the entry hole by a stapler from the Trocar of the left upper abdominal quadrant. After the gloveport was closed, a side-to-side jejunojejunostomy anastomosis applied with another two staples was performed between the afferent loop stump and the roux limb 30 cm below the esophagojejunal anastomosis.

RESULTSThese five patients were all male, and aged (56.8±8.2) years with preoperative clinical stage cT2-4N0-2M0. All the 5 patients underwent SILT-π operation successfully. The average length of surgical incision was (2.9±0.2) cm. The average operation time was (396.0±36.1) minutes. The intraoperative blood loss was (140.0±66.7) ml. Postoperative pathology showed proximal and distal margins were (2.6±1.1) cm and (8.7±2.5) cm apart respectively, and the average number of retrieved lymph node was 25.8±7.2. Perioperative management was based on enhanced recovery following surgical (ERAS) principles. The average time to the first flatus was (2.6±0.5) days, and the average time to defecation was (3.6±0.5) days. The pain score on postoperative day 1 was 1-2, and the average postoperative hospital stay was (7.0±0.7) days. No perioperative complications occurred.

CONCLUSIONSSILT-π procedure is safe and feasible for patients with gastric cancer, and has positive short-term outcomes, satisfactory cosmetic abdominal incision, light postoperative abdominal pain and rapid postoperative recovery. Preliminary observations show that SILT-π procedure has good potential for clinical application in future.

Aged ; Anastomosis, Surgical ; Esophagus ; surgery ; Gastrectomy ; methods ; Humans ; Jejunum ; surgery ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery

Objective To investigate the application value of Braun anastomosis in pancreaticoduodenectomy.Methods The retrospective cohort study was conducted.The clinicopathological data of 389patients who underwent pancreaticoduodenectomy in the Fudan University Shanghai Cancer Center from March 2012 to July 2014 were collected.Of 389 patients,235 receiving Braun anastomosis and 154 receiving non-Braun anastomosis were respectively allocated into Braun anastomosis group and non-Braun anastomosis group.All the patients underwent pancreaticoduodenectomy with digestive tract reconstruction using Child method.Patients in the Braun anastomosis group received 5-10 cm Braun anastomosis between input and output end of jejunum,and patients in the non-Braun anastomosis group didn't receive jejunum-jejunum Braun anastomosis after gastrojejunostomy.Observation indicators included:(1) intraoperative situations;(2) postoperative recovery;(3) follow-up.Patients were followed up using outpatient examination and telephone interview up to May 2015.Follow-up included monthly routine blood retest,hepatorenal function retest and urine and stool routine retest,and enhanced CT scan in the epigastric region for every three months to detect recovery of digestive tract function.Measurement data with normal distribution were represented as x±s.Comparison between groups was analyzed using t test,and count data were analyzed using chi-square test.Results (1) Intraoperative situations:389 patients underwent successful pancreaticoduodenectomy.Standard pancreaticoduodenectomy and pyloric-preserving pancreaticoduodenectomy were respectively applied to 205 and 30 patients in the Braun anastomosis group and 137 and 17 patients in the non-Braun anastomosis group,with no statistically significant difference (x2=0.259,P＞0.05).Anastomosis and reconstruction of pancreatic stump:anastomosis of main pancreatic duct and jejunal mucosa,embedded anastomosis of papillary main pancreatic duct and pancreas-stomach anastomosis were detected in 138,89,8 patients in the Braun anastomosis group and 85,60,9 patients in the non-Braun anastomosis group,respectively,with no statistically significant difference (x2 =1.535,P＞ 0.05).Total operation time,pancreasjejunum anastomosis time and volume of intraoperative blood loss were (398.9 ± 61.9) minutes,(20.6 ±3.5) minutes,(401 ± 59) mL in the Braun anastomosis group and (401.3± 59.2) minutes,(20.7± 2.1) minutes,(407± 159)mL in the non-Braun anastomosis group,respectively,with no statistically significant difference (t =-0.380,-0.562,-0.319,P＞0.05).(2) Postoperative recovery:time to initial anal exsufflation,time for fluid diet intake and time of drainage tube removal were (103 ± 28) hours,(77± 25) hours,(12 ± 5) days in the Braun anastomosis group and (102 ± 31) hours,(79 ± 30) hours,(13 ± 6) days in the non-Braun anastomosis group,respectively,with no statistically significant difference (t =0.330,-0.712,-1.783,P＞0.05).Delayed gastric emptying,gastrointestinal hemorrhage,obstruction of afferent loop and pancreatic fistula were detected in 25,3,0,30 patients in the Braun anastomosis group and 27,4,2,23 patients in the non-Braun anastomosis group,respectively,with no statistically significant difference (x2=3.818,0.918,3.068,0.695,P＞0.05).Seventeen patients were combined with delayed gastric emptying and pancreatic fistula,including 8 in the Braun anastomosis group and 9 in the non-Braun anastomosis group,with no statistically significant difference between the 2 groups (x2=1.363,P＞0.05).Patients with postoperative complications were improved by symptomatic and supporting treatment.Duration of hospital stay and treatment expenses were (14±7) days,(73 205±4 538)yuan in the Braun anastomosis group and (22± 11) days,(83 219±5 738) yuan in the non-Braun anastomosis group,with statistically significant differences between the 2 groups (t=-8.767,-19.139,P＜0.05).(3) Follow-up:389 patients were followed up for 6 months,without death.Six and 9 patients in the Braun anastomosis group and non-Braun anastomosis group had regurgitation cholangitis.There was no readmission due to gastrointestinal hemorrhage and digestive tract obstruction,and no signs of hyperglycaemia and intractable diarrhea occurred.Conclusion Braun anastomosis can reduce duration of postoperative hospital stay and treatment expenses.

Objective To compare the advantages and disadvantages of uniportal video-assisted thoracic surgery(uniportal-VATS)and three portal VATS in treatment of benign pulmonary diseases. Methods The clinical data of 66 patients with benign pulmonary disease treated by VAST from June 2015 to October 2016 were retrospec-tively analyzed. The patients were divided into two groups according to the specific operation. There were 32 patients (18 males and 14 females)in uniportal-VATS group. There were 34 patients(18 males and 16 females)in three portal VATS group. The operative time ,intraoperative blood loss ,thoracic drainage volume at 24 h after opera-tion,incision length,and the time of postoperative drainage of thoracic cavity,postoperative third day pain score and complication rate were compared between the two groups. Results The patients in the experimental and the control groups were successfully operated according to the scheduled protocol. No thoracotomy was performed. There was no statistical difference in the volume of blood loss,the volume of pleural drainage after 24 hours,the time of postoperative drainage of thoracic cavity ,the length of hospital stays and postoperative complications in uni-portal-VATS group and three portal VATS group(P>0.05). The pain score and postoperative third day pain score of the uniportal-VATS group was better than that of the three portal VATS group(P<0.05),but the operation time of the uniportal-VATS group was longer than that of the three portal VATS group(P<0.05). Conclusion Uniportal-VATS is safe and feasible for the treatment of benign lung diseases. It is more minimally invasive and beautiful than traditional three-hole thoracoscopic surgery. It is worthy of promotion and has broad prospects.

Objective To study the function and effect of Oleanolic acid to cholestasis on regulating bile acids transporters. Methods A total of 45 rats were divided into 9 groups,5 rats in each group. The Sham group,Bile duct ligation group and Oleanolic acid group were treated with saline or Oleanolic acid for 3 days,7 days and 14 days. Then the liver and tested bile acids transporters in mRNA and protein lev-els were collected. Results The expression of bile acids transporter OSTβ with Oleanolic acid was increased after 3 days. The expression of OSTβ and BESP in Oleanolic acid group after 7 days were increased than those in Sham group. Fourteen days later,the increasing tendency of OSTα,OSTβ and BSEP were sensiable. Conclusion Oleanolic acid can stimulates the expression of bile acids transporters OSTalpha-beta and BSEP in bile duct-ligation rats.

Objective:To establish a method for determining three residual organic solvents in nimodipine liposomes. Methods:The samples were injected into a DB-624 capillary column (30 m × 0. 32 nm,1. 8 μm) by a headspace sampler and analyzed with an FID detector, the carrier gas was nitrogen, the injector temperature was 250℃, and the detector temperature was 250℃. The column temperature was programmed raised. Results:Three residual solvents, namely ethanol, acetone and acetic ether were completely sepa-rated. There was a good linearity within the experimental concentration range. The average recovery was 98. 9%,98. 5% and 99. 4%(RSD=0. 32%,1. 12%,0. 76%,n=9), respectively. The detection limits was 0. 20, 0. 18 and 0. 22μg·ml-1, respectively . Con-clusion:The method is rapid, sensitive and accurate. It can be used in the determination of residual organic solvents in nimodipine li-posomes.

A new method for the determination of organic acids from mainstream cigarette smoke using ultra low temperature solvent extraction-comprehensive two-dimensional gas chromatography/time-of-flight mass spectrometry(GC×GC-TOF/MS)was established. The mainstream smoke was directly trapped by ethyl ether with ultra low temperature solvent extraction device, and cleaned up with liquid-liquid extraction. The concentrated extracts were further derived by N,O-bis(trimethylsily)trifluoroacetamide (BSTFA). The good separation of silanized product was achieved by the column set of DB-1 (30 m × 0. 25 mm, 1. 0 μm) as the 1st column and DB-wax (1. 5 m × 0. 1 mm, 0. 1 μm) as the 2nd column with modulation period of 6 s and scan range of m/z 45-450 . The results showed that linearity correlation coefficients were larger than 0 . 99 , and the average recoveries were between 80. 17% and 107. 81% with the relative standard deviations (RSD) in the range of 0 . 4%-12 . 1% ( n=5 ) . The detection limit and the quantitation limit were 1 . 3-24 . 5 μg/kg and 4. 1-77. 1 μg/kg, respectively.

Objective:To investigate the effects of various bio-adhesive polymers on bio-adhesive characteristics and release rate of 5-fluorouracil HP-β-CD inclusion complex thermo-sensitive gels. Methods: Bio-adhesive polymer, such as hydroxypropylmethylcellu-lose ( HPMC) , sodium alginate ( SA) , sodium hyaluronat ( HA) ,carbopol and polycarbophil was respectively used to prepare the ther-mo-sensitive gels, and the bio-adhesive force was studied. The phosphate buffer (pH 7. 2) was used and the drug release characteris-tics were studied using dialysis technique. Results: The bio-adhesive force of the gels with 0. 2% polycarbophil was 32. 3 g·ml-1 , and the drug release time was prolonged to 8 h. There was no obvious difference in the dissolution among the gels with the various bio-adhesive polymers. Conclusion:Using 0. 2% polycarbophil as the bio-adhesive polymer, 5-fluorouracil HP-β-CD inclusion complex thermo-sensitive gels show good bio-adhesive force and prolonged drug release characteristics.

Objective:To establish an HPLC method for determining the contents of related substances in vinpocetine injections. Methods:The chromatographic separation was performed on a Kromasil C18 column (150 mm × 4. 6 mm,5 μm). The mobile phase consisted of 0. 2 mol·L-1 ammonium acetate -acetonitrile (40∶60), the flow rate was 1. 0 ml·min-1, the detection wavelength was 280 nm,and the injection volume was 20μl. Results:Vinpocetine and the related substances such as ethyl vincaminate, apovincamine, methoxyvinpocetine and dihydrovinpocetine were separated completely. The calibration curves of related substances showed good linear-ity. The average recoveries of related substances were all above 99. 8%. Conclusion:The method is accurate, sensitive and specific, and can be applied in determining the related substances in vinpocetine injections.