Objective: Traditional Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy can greatly decrease the anastomosis-related complications and reduce the incidence of reflux esophagitis, but its complexity limits the wide application. To decrease the complexity of Kamikawa anastomosis, the surgical team of Changzhi People's Hospital of Shanxi Changzhi Medical College improved this technique by using novel notion and reduced surgical procedures. This study aims to evaluate the efficacy and safety of modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy. Methods: A descriptive cohort study was carried out. Case enrollment criteria: (1) upper gastric carcinoma or esophagogastric junction carcinoma without distant metastasis was confirmed by preoperative gastroscopic biopsy and imaging examination; (2) tumor diameter was less than 4 cm; (3) preoperative clinical staging was cT1-3N1M0. Exclusion criteria: (1) patients received preoperative neoadjuvant chemotherapy; (2) patients had severe heart or lung disease, or poor nutritional status so that they could not tolerate surgery. Clinical data of 25 patients with upper gastric carcinoma or esophagogastric junction carcinoma who underwent modified Kamikawa anastomosis in digestive tract reconstruction in Heji Hospital (8 cases) and Changzhi People's Hospital (17 cases) from April 2019 to December 2020 were retrospectively collected. Of 25 patients, 21 were male and 4 were female, with mean age of 63.0 (49 to 78) years; 3 underwent open surgery and 22 underwent laparoscopic surgery. The modified Kamikawa anastomosis was as follows: (1) the novel notion of total mesangial resection of the esophagogastric junction was applied to facilitate the thorough removal of lymph nodes and facilitate hand-sewn anastomosis and embedding; (2) the diameter of the anastomotic stoma was selected according to the diameter of the esophageal stump, between 2.5 and 3.5 cm, to reduce the occurrence of anastomotic stenosis; (3) an ultrasonic scalpel was used to incise the esophageal stump, which could not only prevent bleeding of the esophageal stump, but also closely seal the esophageal mucosa, muscle layer and serosa to prevent esophageal mucosa retraction; (4) barbed suture was used to suture the remnant stomach fundus and esophagus to fix the stomach fundus in order to reduce the cumbersome and difficult intermittent sutures in a small space; (5) two barbed sutures were used to continuously suture the front and back walls of the anastomosis and complete the suture and fixation of the muscle flap. Relevant indicators of surgical safety, postoperative complications (using the Clavien-Dindo classification), esophageal reflux symptoms and the occurrence of esophagitis (using Los Angeles classification) were analyzed. The gastroesophageal reflux disease (GERD) score, gastroscopy, multi-position digestive tract radiography during postoperative follow-up were used to evaluate the residual gastric motility and anti-reflux efficacy. Results: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy was successfully performed in 25 patients. The surgical time was (5.8±1.8) hours, the intraoperative blood loss was (89.2±11.8) ml, and the average hospital stay was (13.8±2.9) days. Three cases (12.0%) developed postoperative anastomotic stenosis as Clavien-Dindo grade III and were healed after endoscopic dilation treatment. Postoperative upper gastrointestinal radiography showed 1 case (4.0%) with reflux symptoms as Clavien-Dindo grade I. Gastroscopy showed no signs of reflux esophagitis, and its Los Angeles classification was A grade. No anastomotic bleeding, local infection and death were found in all the patients. At postoperative 6-month of follow-up, GERD score showed no significant difference compared to pre-operation (2.7±0.6 vs. 2.4±1.0, t=-1.495, P=0.148). Conclusion: Modified Kamikawa anastomosis in digestive tract reconstruction after proximal gastrectomy is safe and feasible with good anti-reflux efficacy.
Aged ; Anastomosis, Surgical ; Cohort Studies ; Esophagogastric Junction/surgery* ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Retrospective Studies

With the gradual increase in the diagnosis rate of early gastric cancer, clinicians must consider prevention of gastric anatomical structure and physiological function while ensuring the radical treatment of the tumor. Pylorus-preserving gastrectomy is a function- preserving operation that preserves the pylorus, inferior pyloric vessel, and the vagus nerve in patients with early middle gastric cancer. One of the major controversies at present is the thoroughness of limited lymph node dissection for pyloric-preserving gastrectomy. Various studies have reported that the lymph node metastasis rate of early middle gastric cancer was low, especially in the suprapyloric region, inferior pylorus and the upper pancreatic region. Partial lymph node dissection is required for vascular and neurological protection, which is also safe and feasible in studies reported by major centers. Many clinical studies have been carried out in Japan and Korea, and postoperative follow-up has gradually increased evidence, providing the basis for the safety of lymph node dissection. In large case studies comparing pylorus- preserving gastrectomy with traditional distal gastrectomy, the incidence of postoperative morbidity, such as dumping syndrome, bile reflux esophagitis, weight loss, and malnutrition is low. Sentinel lymph node navigation technology is gradually applied to the diagnosis and treatment of early gastric cancer, and its clinical application value still needs further research.
Humans ; Pylorus/pathology* ; Stomach Neoplasms/pathology* ; Gastrectomy ; Gastroenterostomy ; Lymph Node Excision

Objective Compared with different decellularization procedures for their potential of cell removal and the ability to preserve the matrix. Methods Specimens of bovine pericardiums were treated by 3 approaches (detergent and enzyme extraction、trypsin 、Triton-X 100 and sodium-deoxycholate). Tissue samples were then observed by HE staining and scanning electron microscopy to confirm the removal of cells. Von Gieson(VG) staining and Gomori staining were used for showing the integrity of collagen and elastin. DNA content was examined by the method of DNA extraction. Tissue shrinkage temperature and mechanical properties were also studied. Results Completely decellularization were achieved in 3 groups. While trypsin、Triton-X 100 and sodium-deoxycholate caused severe structural destruction and declined of mechanical properties of the matrix. In contrast, detergent and enzyme extraction achieved completely deeellularization and effectively preservation the matrix structure. Conclusion This research demonstrated detergent and enzyme extraction could achieve both complete decellularization and preservation of the matrix structure. This approach may provide an ideal platform for the construction of tissue-engineering heart valves.

Objective: Based on the strategy of network toxicology, the potential mechanism of renal injury in rats induced by Phytolaccae Radix was preliminarily explored. Methods: Firstly, by consulting the online database and mining the text, the chemical composition library of Phytolaccae Radix was established. The reverse molecular docking technology based on pharmacophores was performed to predict the relevant targets of chemical components and the target of nephrotoxicity induced by Phytolaccae Radix was obtained by intersecting with the target of nephrotoxicity. Potential substance basis of nephrotoxicity induced by Phytolaccae Radix was obtained by reverse analysis. Secondly, a large-scale protein-protein interactions were used to screen key targets, and key pathways for nephrotoxicity were analyzed by GO and KEGG biological annotation. Finally, a rat model of nephrotoxicity induced by esculentoside A was constructed and molecular biology methods were used to detect the expression of important targets in related pathways. Results: A total of 56 chemical components and 148 potential targets were obtained through literatures and related databases. Among them, 38 components, 34 targets, and 93 pathways were closely related to the generation of nephrotoxicity, mainly involving TNF signaling pathway, calcium signaling pathway, NF-κB signaling pathway, and VEGF signaling, thus participating in the beginning and end of nephrotoxicity events. Pathological results showed that the kidney tissues of rats were damaged to varying degrees after 7 d of treatment with esculentoside A. Western blot showed that the expression of IκBα was down-regulated (P < 0.01) and the expression of p-IκBα was up-regulated (P < 0.05). Quantitative detection of TNF-α and IL-1β by ELISA showed that both expressions were up-regulated (P < 0.05). Conclusion: Network toxicology can be used to preliminarily screen potential toxic substances. Esculentoside A based on network toxicology screening can induce nephrotoxicity in rats. Its molecular mechanism is related to activation of NF-κB signaling pathway and overexpression of inflammatory factors.

Standardized surgical management of postoperative specimens of gastric cancer is an important part of the standardized diagnosis and treatment of gastric cancer. It can reflect the accurate number and detailed distribution of lymph nodes in the specimen and lay the foundation for accurate and standardized pathological reports after surgery. Meanwhile, it can evaluate the scope of intraoperative lymph node dissection, the safety of cutting edge, and the standardization of surgery (principle of en-bloc dissection), which is an important means of surgical quality control. It also provides accurate research samples for further research and is an important way for young surgeons to train their clinical skills. The surgical management of postoperative specimens for gastric cancer needs to be standardized, including specimen processing personnel, processing flow, resection margin examination, lymph node sorting, measurement after specimen dissection, storage of biological specimens, documentation of recorded data, etc. The promotion of standardized surgical management of specimens after radical gastrectomy can promote the homogenization of gastric cancer surgical diagnosis and treatment in medical institutions and further promote the high-quality development of gastric cancer surgery in China.
Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes/surgery* ; Stomach Neoplasms/surgery*

With the increasing detection rate of early upper gastric cancer and adenocarcinoma of esophagogastric junction, the safety of proximal gastrectomy with clear indications has been verified, and function-preserving proximal gastrectomy has been widely used. However, proximal gastrectomy destructs the normal anatomical structure of esophagogastric junction, resulting in severe postoperative gastroesophageal reflux symptoms and seriously affecting the quality of life. Among various anti-reflux surgery methods, reconstruction of "cardiac valve" has always been the focus of relevant scholars because its similarity with the mechanism of normal anti-reflux. After years of development, evolution and optimization, the designed seromuscular flap anastomosis includes tunnel muscle flap anastomosis, Hatafuku valvuloplasty, single muscle flap anastomosis and double muscle flap anastomosis. The double muscle flap anastomosis has become a research hotspot because it shows good anti-reflux effect in clinical application. This paper reviews the history, research status and hot issues of seromuscular flap anastomosis of esophageal remnant stomach at home and abroad.
Anastomosis, Surgical/methods* ; Esophagogastric Junction/surgery* ; Gastrectomy/methods* ; Gastroesophageal Reflux/surgery* ; Humans ; Quality of Life ; Stomach Neoplasms/surgery*

The quality control and standardization of procedures in radical gastrectomy for gastric cancer, especially the standardized processing of specimens after radical gastrectomy for gastric cancer, is very important. It is not only the basis of accurate pathological staging, but also the evidence of surgical quality and the original data of clinical research, which plays a pivotal role. The examination and classification of lymph nodes, specimens processing records, and data uploading and archiving after radical gastrectomy for gastric cancer are indispensable. It is necessary for surgeons to participate in the processing of surgical specimens. This article will combine the current research status and progress at home and abroad to review the standardized processing of specimens after radical gastrectomy for gastric cancer.
Gastrectomy ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Neoplasm Staging ; Stomach Neoplasms/surgery*

Objective To explore the probability and associated factors of pulmonary fibrosis in 350 cases of elderly pneumonia. Methods Elderly patients who received diagnosis and treatment at Changzhi Medical College Affiliated Peace Hospital from January 2018 to December 2022 were selected, and 350 patients who met the criteria were included in the study. Analyze its clinical data, incidence of pulmonary fibrosis, and analyze the relationship between the two. Results The average age of 350 patients was (63.51 ± 5.74) years old; 219 cases were common type , 72 cases were severe type, and 59 cases were critically ill. At admission, the CT signs were: ground glass in 66 cases (18.86%) , paving stone in 37 cases (10.57%), consolidation in 73 cases (20.86%), nodules in 93 cases (26.57%) , fried egg sign in 20 cases (5.71%) , and mosaic sign in 61 cases (17.43%). At discharge, the lesion signs were as follows: 61 cases (17.43%) had no lesions, 207 cases (59.14%) maintained the original lesion signs, and 82 cases (23.43%) evolved into other signs. 76 cases of pulmonary fibrosis were discharged, with an incidence rate of 21.71%. There were significant differences in the incidence of pulmonary fibrosis among patients with different ages, lesion evolution during treatment, lesion signs at discharge, and clinical stages (all P<0.001). Pulmonary fibrosis is positively correlated with age (P=0.047), lesion signs at discharge (P=0.032), and clinical classification (P=0.010). The incidence of lesions presenting as paving stones (P=0.014) and fibrosis in critically ill patients (P=0.013) at discharge is higher. Age increase (P=0.047) , wide range of lesions at admission (P=0.042), evolution of lesions into other signs at discharge (P=0.016), and clinical classification as severe (P=0.008) or critically ill (P=0.021) are independent risk factors for the development of pulmonary fibrosis in elderly pneumonia patients. Conclusion The incidence of pulmonary fibrosis in elderly patients exceeds 20%. Increasing age, wide range of lesions upon admission, evolution of lesions into other signs upon discharge, and clinical classification as severe or critically ill are independent risk factors for the occurrence of pulmonary fibrosis in elderly pneumonia patients.

italic>Sophora flavescens is a traditional Chinese medicine rich in flavonoids and has wide application potential in drug development and clinical practice. In this study, a total of 227 flavonoids were detected among five tissues of S. flavescens during anthesis using widely targeted metabolomics techniques. There were 137 flavonoids shared by five S. flavescens tissues and 18 root-specific flavonoids. There were 156, 155, 156 and 150 differentially accumulated metabolites identified in stem, leaf, flower, and young pod, respectively, compared with root. Forty-seven potentially active flavonoid components in S. flavescens were identified using the PubChem and SwissADME databases. The 58 potential target proteins for these potentially active components were predicted to be important in the treatment of type 2 diabetes mellitus (T2DM) based on the SwissTargetPrediction and GeneCards database. These 58 target proteins were used to construct a protein-protein interaction network through the STRING database, from which we performed GO and KEGG functional enrichment analysis. The mechanisms by which S. flavescens flavonoids may be useful in the treatment of T2DM was further explored in a multi-level and systematic way based on a "component-target-pathway" network. Finally, ten key potentially effective components were identified and found to be mainly distributed in the roots, flowers, and pods, and their content varied significantly between tissues. The results predict that the key targets of S. flavescens flavonoids in the treatment of T2DM are AKT1, ESR1, EGFR, PIK3R1, TNF and PTGS2, and that they play a hypoglycemic role through the regulation of endocrine resistance, AGE-RAGE, the PI3K-Akt signaling pathway, EGFR tyrosine kinase inhibitor resistance and other signaling pathways. This analysis of the tissue distribution and network pharmacology of S. flavescens flavonoids provides a theoretical basis for further studies on S. flavescens metabolites, the rational development and utilization of the S. flavescens aboveground parts, and initiates a comprehensive exploration of the mechanisms by which S. flavescens can be used in the treatment of T2DM.

OBJECTIVE: To develop a new scattering spectra method for the determination of tetramethylpyrazine.