Objective:To study the feasibility and efficacy of the modified posterolateral laparoscopic approach for resection of massive splenomegaly.Methods:The data of 48 patients who underwent laparoscopic splenectomy for massive splenomegaly at the Affiliated Hospital of Jiangnan University (Wuxi 4th People's Hospital) from January 2016 to July 2019 were retrospectively analyzed. There were 29 males and 19 females, with an average age of 55.8 years. These 48 patients were divided into two groups according to the operative approach, the study group ( n=26) using the modified posterolateral approach which treated the splenic pedicle as the last step; and the control group ( n=22) which used the posterior tunnel of splenic pedicle established by anterior approach to treat the splenic pedicle first. The operation time, gastrointestinal function, recovery time, intraoperative blood loss, rates of conversion to laparotomy and postoperative complications were compared between two groups. The follow-up data were also analyzed. Results:There were no significant differences in operation gastrointestinal function recovery and hospitalization time between the two groups (all P>0.05). The intraoperative blood loss, numbers of patients with convention to open surgery and intraoperative blood transfusion, were (50.2±15.1) ml vs (160.1±40.3) ml, 2 patients (7.7%) vs 7 patients (31.8%), and 1 patients (3.8%) vs 5 patients (22.7%), in study group and control group respectively. The differences between groups were significant (all P<0.05). The complications of the study group and control group were 9 patients (34.6%) vs 13 patients (59.1%), which were significantly in the two groups ( P<0.05). On follow-up which ranged from 1 to 15 months, the numbers of patients with thrombocytosis and portal vein thrombosis in the study group and the control group were 20 patients (76.9%) vs 17 patients (77.3%), and 7 patients (26.9%) vs 6 patients (27.3%), respectively. Conclusion:The modified posterolateral laparoscopic approach for resection of massive splenomegaly was safe and feasible. It should be promoted to treat massive splenomegaly.

Objective: To investigate the effects of genistein (Gen) on bone turnover in ovariectomized rats. Methods: Forty-seven Wistar rats were randomly allocated into six groups: sham-operated (sham), ovarietomized (ovx), ovarietomized plus diethyl stilbestrol [E, 20?g/(kg bw?d)] or Gen [25、50、100 mg/(kg bw?d)] administration. After the rats had been fed for 3 mo,bone mineral density (BMD), histomorphometric parameters, the serum concentration of osteocalcin (BGP) and urinary contents of pyridine and hydroxyproline (HYPRO) were analysed. Results: BMD, trabecular bone volume (TBV) and mean trabecular plate density (MTPD) of ovariectomized rats were significantly decreased, but serum concentrations of BGP,urinary contents of deoxypyridinoline and HYPRO and mean trabecular plate space (MTPS) increased compared with the sham. After 3 mo of Gen supplementation, TBV,MTPD and urinary deoxypyridinoline were improved significantly in ovariectomized rats. Conclusion: Genistein reduced bone loss in ovariecromized rats by suppressing bone metabolism and osteoclast activity.

BACKGROUND: Genistein is the main component of phytoestrogen soy isoflavone and its structure is similar to estrogen,which suggests that it might prevent or delay osteoporosis. Research on the effects of genistein on bone mineralization and calcium(Ca), phosphor(P), zinc(Zn) and magnesium (Mg) in ovariectomized rats are rare.OBJECTIVE: To investigate the effects of genistein on bone mineralization and Ca,P,Zn and Mg in ovariectomized rats to provide a theoretical gist for the prevention of osteoporosis by genistein.DESIGN: A controlled experiment based on experimental animals.SETTING: Department of Nutrition,General Hospital of Chinese PLA.MATERIALS: The study was conducted in the Institute of Hygiene and Environmental Medicine,Academy of Military Medical Sciences of PLA between February and June 2003. Ten-week old female Wistar rats [certification number: (military medical animal): D98014] with a body mass of(170±20) g were selected.INTERVENTIONS: Experimental animals were fed with normal feeding for 6 weeks and then the feeding was changed to AIN-93 compound. Animals were then randomly divided into ovariectomized group (n=40) and sham-operation group(n=7) based on bodyweight after 5 days. Ovariectomized group received ovariectomy and sham-operation group only received abdominal incision. After 5 days of recovery,the ovariectomized group was further randomly divided into 5 subgroups with 8 rats each including ovariectomized control subgroup,estrogen subgroup [diethylstilbestrol 20 μg/(kg · d)],genistein Ⅰ,Ⅱ,or Ⅲ subgroup[dose of 25,50 or 100 mg/(kg · d)]. After 3months of feeding,6 rats were randomly selected from each group for the detection of bone density and corresponding bone hismorphometric indicators.MAIN OUTCOME MEASURES: Bone density,corresponding parameters of bone mineralization,Ca,P,Zn and Mg contents in bone of mice in each group RESULTS: After ovariectomy,femoral bone density decreased [(0. 247± 0.007) g/cm2],mean osteoid width increased[(7. 04 ±0. 32)μm],bone mineralization delayed [(4.96±0.99) days],osteoid maturity prolonged [(26.99±7.70) days],and Ca[ (251.11± 5.31) mg/g],P[(115.08± 3.78) mg/g],Zn[ (299.69±37.1)μg/g] and Mg[(4. 32±0. 12) μg/g]were all significantly different from that of sham-operation group(P<0.05).After the application of genistein,femoral bone density had a tendency of improvement[ (0. 250±0. 007) g/cm2],mean osteoid width narrowed[ (4. 97±0.77) μm],bone mineralization delayed time[ (3.18±0.69) days] and osteoid maturity time[(14.53 ±3.84) days] shortened, contents of Ca [(270.00±5.65) mg/g],P[(124.25±2.37) mg/g] andMg[(4.61±0. 08) μg/g]elevated while Zn content had no significant changes.CONCLUSION: Genistein promotes osteoid mineralization,reduces the loss of Ca, P and Mg in the bone and prevent the generation of osteoporosis in unsexed rats

Cancer is a global chronic disease and extremely harmful to human health. Cancer patients will have the feeling of become a burden to others in the treatment process, this feeling is called self-perceived burden. self-perceived burden will add to the psychological burden of patients, influence the patient's quality of life and treatment decisions for cancer treatment and recovery. In this article, by analyzing the domestic and foreign scholars on the research of self-perceived burden of cancer patients, highlight the patients self-perceived burden level and influencing factors, provide basis for clinical nursing workers to improve psychological status in cancer patients.

Taking the construction of medical ethics and medical ecological governance as the research focus, taking the guidance of the socialist ideology of Chinese characteristics in the new era of Xi Jinping, focusing on the health needs of people, it should scientifically analyze problems of unbalanced and insufficient development of the medical and health undertakings, establish the medical ethics construction concept of adapting market and surpassing market, eliminate institutional obstacles to interest and the idea of reform resistance, and vigorously strengthen the party' s organizational leadership over the construction of medical ethics. Through establishing a legal security system, it should establish a scientific supervision system and build the whole process and continuous education system, to promote the healthy development of medical and health undertakings, and constantly promote the modernization of medical ethics construction and medical ecological governance capabilities.

Objective To evaluate the feasibility and safety of a delivery pathway for the performance of percutaneous left atrial appendage (LAA) occlusion in experimental canine models. Methods Transseptal puncture was performed via femoral vein approach under fluoroscopic and angiographic guidance in 12 experimental dogs. A pigtail catheter was advanced into the left atrium (LA), which was followed by LA angiography. The diameters of the neck of LAA were measured on LAA angiogram obtained in appropriate projection. After the delivery sheath was advanced along the wire into LA, a pigtail catheter was inserted into the ostium of the LAA and the sheath was then advanced over the pigtail into the LAA. LAA angiography was then performed through the delivery sheath to confirm the position of the delivery sheath. One hour after the procedure both electrocardiography (ECG) and transthoracic echocardiography (TTE) were carried out in five dogs to check the results, immediately after which the five dogs were sacrificed to macroscopically observe the damages of the puncture site of inter-atrial septum as well as inside the LA and LAA. One hour and 2 weeks after the procedure TTE was conducted in the remaining 7 dogs and these dogs were followed up for one month. Results One dog died of pericardial tamponade during the operation. In 8 dogs the LAA was clearly displayed in the projection position of right anterior oblique (RAO) 30°/cranial (CRA) 20°,while in 3 dogs the LAA was well visualized in the projection position of RAO 30° , and in one dog in the projection position of RAO 30°/caudal (CAU) 20°. The diameter of LAA neck was (13.6 ± 5.2) mm. The delivery sheath was safely advanced into the LAA along the pigtail catheter in all dogs, and no air embolism, thrombus or pericardial tamponade occurred. Hematoma at puncture point of groin occurred in 2 dogs, which was absorbed through pressure dressing. Macroscopic examination of the heart performed immediately after the operation showed that no bloody pericardial effusion was found, and mild hematoma at posterior wall of LA was seen in one dog and mild damage of the upper-margin intima of LAA was noted in 2 dogs. The mean fluoroscopy time was (10.1 ± 2.5) minutes and the mean operation time was (58 ± 12) minutes. TEE showed no pericardial effusion 2 weeks after the procedure. During the follow-up period of one month no sudden death, stroke or infection occurred. Conclusion This method of placing the delivery sheath into the LAA is clinically safe and effective, and it can reliably establish a pathway to advance the LAA occluder into LAA.

Objective To compare the efficacy of surgical drainage versus repair in the treatment of iatrogenic injury of the distal common bile duct detected during operation,and to evaluate the effect of gastrobiliary duct drainage.Methods Patients with iatrogenic choledochal injury were divided into two groups:the drainage group (n =17) and the repair group (n =7).Data on the amounts of postoperative biliary and abdominal cavity drainage,gastrointestinal function recovery,the duration of biliary drainage and hospitalization were compared.Results When compared with the repair group,there were no significant differences in the amounts of postoperative biliary drainage [(310.0± 112.0) vs.(264.0± 144.0) ml] and abdominal cavity drainage [(42.0±25.0) ml vs.(125.0± 195.0) ml)] (both P＞0.05).However,gastrointestinal function recovery [(3.0±1.5)d vs.(4.7±2.0)d],durations of biliary drainage [(7.5±1.0)d vs.(12.7±5.4)d] and hospitalization [(9.5±1.5)d vs.(15.1±5.6)d] of the drainage group were significantly shorter than the repair group (P＜ 0.05).No biliary strictures of cholangitis were detected in the two groups.Conclusion When compared with traditional repair,gastrobiliary drainage was a simpler,safer,and more effective therapeutic strategy for patients with iatrogenic distal common bile duct injury,and with a quicker recovery after treatment.

OBJECTIVETo analyze the efficacy and safety of laparoscopic adjustable gastric placation (LAGBP), a new procedure for surgical treatment of obesity.

METHODSClinical and 1-year follow-up data of 10 patients who underwent LAGBP in our department between September and November 2011 were analyzed retrospectively.

RESULTSThe mean operative time was (93.0±13.4) min, while the mean intraoperative blood loss was (15.5±4.7) ml. The mean excessive body weight loss rate(%EWL) at 3, 6, 9 and 12 months after the operation was 25.1%, 40.6%, 45.3% and 50.8% respectively. There were no severe post operative complications.

CONCLUSIONSLAGBP is associated with high safety and good short-term efficacy.

A recurrent misdiagnosed case of congenital left renal arteriovenous fistula (RAVF) with multiple left renal arteries and scoliosis was reported. The patient was admitted to hospital on 29 August 2020 due to repeated hematuria for one year. No abnormality was found in two flexible ureteroscope examinations, imaging and laboratory examinations after admission. It was found that the structure of blood vessels in the inferior pole of renal sinus was disordered, and the blood vessels were tortuous and clustered through careful reading of CT enhancement films. The dilated tortuous blood vessels were also seen around the renal pelvis, and hematuria was considered to be caused by renal vascular malformation. In order to confirm the etiology, digital subtraction angiography (DSA) of renal artery was performed. DSA showed a congenital left renal RAVF with three renal arteries, and the arteriovenous fistula of renal arteries was embolized. For patients presenting with severe gross hematuria, if tumor, stone, tuberculosis, or coagulation abnormalities were excluded by conventional imaging and/or laboratory examination the possibility of congenital renal vascular malformation should be suspected, and DSA examination should be performed. Endovascular embolization is an effective treatment for congenital RAVF.

Objective : Angiotensin Ⅱ Type 2 receptor (AT2R) is a major receptor of angiotensin Ⅱ , which has a protective effect on damage to various tissues and organs．In this study，an overexpression plasmid of AT2R was con- structed to explore the effect of overexpression of AT2R on lipopolysaccharide ( LPS ) -induced inflammatory re- sponse in mouse hepatocytes (AML12 cells) ． Methods : Mice tissues and organs were used as samples to amplify the gene of interest (AT2R) fragments containing EcoR Ⅰ and Hind Ⅲ restriction sites，and then the final product was obtained by digestion and ligation．The final positive clones were sequenced and identified．The pCMV-Flag-N- AT2R plasmid was transfected into HEK 293T cells，and the expression of Flag protein was detected by the Western blot method after 24 h．AT2R expression on AML12 cells was observed by Western blot and laser confocal microsco- py．AML12 cells were treated differently and divided into control group，LPS treatment group，pCMV-Flag-N-AT2R group and pCMV-Flag-N-AT2R + LPS group，and cell viability was detected by CCK8．Western blot detected PCNA proteins and observed cell proliferation ; Cytoinflammatory factor levels were detected by qPCR ; Western blot detec- ted the expression level of nuclear transcription factor NF-кB (p65) in cells. Results : The identification and se- quencing results of EcoR I and Hind III double restriction showed that pCMV-Flag-N-AT2R plasmid was successful- ly constructed，and the detection results of the Western blot method showed successful expression of AT2R protein. Laser confocal observed that there were AT2R receptors on AML12 cells，and AT2R recombinant plasmids could be expressed on AML12; Compared with the control group，the viability and proliferation ability of LPS-treated AML12 cells were weakened，while the levels of IL-6 and TNF-α increased，and the expression level of nuclear transcription factor NF-кB (p65) increased．Compared with the LPS group，the viability and proliferation of cells in AML12 cells treated with pCMV-Flag-N-AT2R and LPS were enhanced，while the levels of IL-6 and TNF-α decreased．The ex- pression of the nuclear transcription factor NF-кB ( p65 ) decreased． Conclusion AT2R overexpression plasmids were successfully constructed and successfully expressed on AML12 cells，and AT2R could inhibit the inflammatory response of LPS-induced AML12 cells.