Objective To discuss the safety and efficacy of inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture.Methods There was an retrospective analysis on operation videos and clinical data for 16 participants of inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture with the period from March in 2012 to September in 2015. And these were statistically analyzed including the operation time, intraoperative bleeding volume, postoperative drainage volume, removal time of drainage tube, admission time after operation and the incidence of postoperative complications of vesicoureteric reflux and stenosis.Results The operations of 16 participants were completed successfully without converting to open surgery. The operation time was 60 ~ 125 min (Mean time: 85 min); intraoperative bleeding volume was 20 ~ 50 ml (Mean volume: 32 ml); postoperative drainage volume was 60 ~ 400 ml (Mean volume: 106 ml); removal time of drainage tube was 3 ~ 6 d (Mean time: 4.2 d) and admission time after operation was 7 ~ 10 d (Mean time: 8.5 d). There was the follow-up with 6 ~ 18 months (Mean time: 12 months) for participants. No anastomotic stenosis was present. In addition, one participant was suffered from mild vesicoureteric relfux. And there was no aggravation during 18 months.Conclusions The inserting ureterovesical reimplantation by means of laparoscopy associated with six-stitch suture was safe and effective. It was found that the operation time was significantly shortened and the incidence of postoperative complications of vesicoureteric relfux and anastomotic stenosis was not increased. By contrast, the six-stitch suture could reduce the incidence of anastomotic stenosis.

Objective To study the effects of dust mite immunotherapy on the hormonal dosage, specific immunoglobulins G4(sIgG4)level and pulmonary function in asthmatic children.Methods One hundred and twenty-four cases of asthmatic children were randomly divided into specific immunotherapy treatment(SIT) group (62 cases, treated with the dust mite immunotherapy) and inhaled corticosteroids (ICS) group (62 cases, treated with ICS). The changes of clinical symptoms, serum sIgG4 level, pulmonary function and ICS dosage before and after treatment were compared between two groups. Results After treatment for 12,18,and 24 months, the scores of childhood asthma control test(C-ACT) in SIT group were significantly higher than those in ICS group:(23.84 ± 1.15)scores vs.(22.75 ± 1.08) scores, (24.29 ± 1.27)scores vs.(23.17 ± 1.22)scores, (24.83 ± 1.40)scores vs.(23.88 ± 1.34)scores, there were significant differences (P<0.05). After treatment for 12, 24 months, the level of serum sIgG4 in SIT group were significantly higher than those in ICS group:(308.75 ± 102.96) μg/L vs. (239.64 ± 79.35) μg/L, (542.28 ± 113.37) μg/L vs. (243.65 ± 80.21) μg/L, there were significant differences (P<0.05). After treatment for 12, 24 months, the levels of percentage of forced expiratory volume in 1 second (FEV1%), percentage of maximal expiratory flow rate (PEF%) in SIT group were significantly higher than those in ICS group: FEV1%:(95.82 ± 7.64)% vs. (92.79 ± 8.52)%, (99.52 ± 8.17)% vs.(95.89 ± 7.53)%;PEF%:(95.78 ± 5.85)% vs.(93.54 ± 6.18)%,(99.77 ± 5.69)% vs. (97.61 ± 5.56)%, there were significant differences (P<0.05). After treatment for 12, 24 months, the scores of daytime asthma symptoms scale (DAS) and nocturnal asthma symptoms scale (NAS) in SIT group were significantly lower than those in ICS group:DAS:(1.75 ± 0.54)scores vs.(1.96 ± 0.60)scores, (0.84 ± 0.27) scores vs. (1.19 ± 0.38) scores;NAS: (0.75 ± 0.27) scores vs.(0.92 ± 0.30) scores, (0.55 ± 0.18)scores vs.(0.81 ± 0.24)scores, there were significant differences(P<0.05).After treatment for 12, 24 months, the dosage in SIT group was significantly lower than those in ICS group:(172.08±16.73)μg/d vs.(194.63 ± 14.17)μg/d,(138.09 ± 16.23)μg/d vs.(163.15 ± 15.38)μg/d, there were significant differences(P<0.05).Conclusions Dust mite immunotherapy can effectively improve the clinical symptoms and pulmonary function in children with dust mite allergy asthma and reduce the ICS dosage, it may be related to the increase of protective antibody sIgG4 in children.

OBJECTIVETo compare the prognostic value of lymph node ratio and N staging in stage III colorectal cancer.

METHODSThe clinicopathologic factors and follow-up data of 304 cases with stage III colorectal cancer from January 1998 to December 2011 were analyzed retrospectively. Multivariate analysis was performed using Cox proportional hazard regression model in forward stepwise regression. Patients were divided into different subgroups according to the number of lymph nodes sample.

RESULTSLNR and N stage were independent risk factors for stage III colorectal cancer, the prognostic value of LNR was better than that of N stage [Odds ratio were 1.838(95% CI:1.563~2.161) vs. 1.625 (95% CI:1.392~1.898)]. Subgroup analysis showed that, when the number of lymph nodes sample was less than 13, the prognostic value of LNR was better than that of N stage (Odds ratio were 1.836 vs. 1.639). But when the number of lymph nodes sample was more than 13, they were comparable (Odds ratio were 1.876 vs. 1.853).

CONCLUSIONSThe prognostic value of LNR and N stage were comparable for stage III colorectal cancer, but when the number of lymph nodes sample was less than 13, LNR was more valuable.

Objective To compare the prognostic value of lymph node ratio and N staging in stage Ⅲ colorectal cancer. Methods The clinicopathologic factors and follow-up data of 304 cases with stage Ⅲ colorectal cancer from January 1998 to December 2011 were analyzed retrospectively. Multivariate analysis was performed using Cox proportional hazard regression model in forward stepwise regression. Patients were divided into different subgroups according to the number of lymph nodes sample. Results LNR and N stage were independent risk factors for stage Ⅲ colorectal cancer, the prognostic value of LNR was better than that of N stage [Odds ratio were 1.838(95% CI:1.563~2.161) vs. 1.625 (95% CI:1.392~1.898)]. Subgroup analysis showed that, when the number of lymph nodes sample was less than 13, the prognostic value of LNR was better than that of N stage (Odds ratio were 1.836 vs. 1.639). But when the number of lymph nodes sample was more than 13, they were comparable(Odds ratio were 1.876 vs. 1.853). Conclusions The prognostic value of LNR and N stage were comparable for stage Ⅲ colorectal cancer, but when the number of lymph nodes sample was less than 13, LNR was more valuable.

Objective To compare the prognostic value of lymph node ratio and N staging in stage Ⅲ colorectal cancer. Methods The clinicopathologic factors and follow-up data of 304 cases with stage Ⅲ colorectal cancer from January 1998 to December 2011 were analyzed retrospectively. Multivariate analysis was performed using Cox proportional hazard regression model in forward stepwise regression. Patients were divided into different subgroups according to the number of lymph nodes sample. Results LNR and N stage were independent risk factors for stage Ⅲ colorectal cancer, the prognostic value of LNR was better than that of N stage [Odds ratio were 1.838(95% CI:1.563~2.161) vs. 1.625 (95% CI:1.392~1.898)]. Subgroup analysis showed that, when the number of lymph nodes sample was less than 13, the prognostic value of LNR was better than that of N stage (Odds ratio were 1.836 vs. 1.639). But when the number of lymph nodes sample was more than 13, they were comparable(Odds ratio were 1.876 vs. 1.853). Conclusions The prognostic value of LNR and N stage were comparable for stage Ⅲ colorectal cancer, but when the number of lymph nodes sample was less than 13, LNR was more valuable.

Objective To investigate the changes of airway function in different stages of asthma and its detection value.Methods One hundred and twenty children with acute exacerbation of asthma were selected as acute exacerbation group. The children were treated with routine asthma for 1 month. After that, children went into chronic duration (chronic duration group). The pulmonary function was measured in acute exacerbation group and chronic duration group,and the indexes were compared with those of 60 healthy children(healthy control group). Results The pulmonary function indexes of large airway forced vital capacity(FVC),peak expiratory flow(PEF),forced expired volume in 1 second(FEV1) and FEV1/FVC in acute exacerbation group were significantly lower than those in healthy control group and chronic duration group:(1.398 ± 0.518)L vs.(1.942 ± 0.557)and(1.851 ± 0.453)L,(2.701 ± 0.901) L/s vs.(4.102 ± 0.971)and(3.840 ± 1.001)L/s,(1.201 ± 0.316)L vs.(1.841 ± 0.499)and(1.690 ± 0.401) L, (86.337 ± 8.769)% vs. (96.589 ± 4.069)% and (94.317 ± 6.311)%, and there were statistical differences (P<0.05). The FEV1/FVC in chronic duration group was significantly lower than that in healthy control group,and there was statistical difference(P<0.05).There were no statistical differences in FVC, PEF and FEV1between chronic duration group and healthy control group (P>0.05). The pulmonary function indexes of small air channel forced expired flow at 25% of FVE (FEF25%), forced expired flow at 50% FVE (FEF50%), forced expired flow at 75% of FVE (FEF75%) and maximal midexpiratory flow (MMEF) in acute exacerbation group were significantly lower than those in healthy control group and chronic duration group:(2.187 ± 0.866)L/s vs.(3.869 ± 0.891)and(3.489 ± 0.947)L/s, (1.291 ± 0.549)L/s vs.(2.871 ± 0.584)and(2.599 ± 0.701)L/s,(0.596 ± 0.231)L/s vs.(1.412 ± 0.461) and(1.191 ± 0.571)L/s,(1.087 ± 0.496)L/s vs.(2.507 ± 0.629)and(2.259 ± 0.584)L/s,the indexes in chronic duration group were significantly lower than those in healthy control group, and there were statistical differences (P<0.05). Conclusions The lung function is abnormal in asthma children with acute exacerbation.After entering the chronic duration,the lung function appears to be improved,and the large airway function indexes return to normal. The small airway function indexes do not recover completely.Therefore,the detection of small airway function has great value in the diagnosis,severity and treatment of asthmatic children.

Objective To set up a computer-assisted polyp detection system under colonoscopy,and to preliminarily verify its effectiveness.Methods Based on Faster R-CNN algorithm and the open source implementation of the open source framework tensorflow and Faster R-CNN,a computer-assisted polyp detection system under colonoscopy was constructed.According to the size and difficulty of the training set,five test groups were set up:test group one,two,three and four contained 1 000,2 000,4 000 and 6 000 training samples,respectively.Test group five increased the probability of selecting the difficult samples based on 6 000 training samples.In different training sets,the sensitivity,specificity,other classification evaluation parameters,and the evaluation parameters of target detection such as recall and precision of this polyps detection system were calculated.Results Classification evaluation parameters showed that the sensitivities of test group one,two,three,four and five were 90.1％,93.3％,93.3％,93.3 ％ and 93.5 ％,respectively,and the difference was statistically significant (x2 =25.324,P＜0.01).The sensitivities of test group two,three,four and five were all higher than that of test group one,and the differences were statistically significant (x2 =13.964,13.508,13.508 and 13.386,all P＜ 0.006 25).There were no significant differences in specificity and positive predictive value among test groups (both P＞0.05).The negative predictive values of test group one,two,three,four and five were 90.4％,93.3％,93.3％,93.3％ and 93.5％,respectively,and the differences were statistically significant (x2 =21.862,P＜0.01).The negative predictive values of test group two,three,four and five were higher than that of test group one,and the differences were statistically significant (x2=11.447,11.564,11.755,13.760;all P＜0.006 25).As the training sample size increased from 1 000 to 2 000,the area under curve (AUC) increased by 2％,and further increased the sample size to 6 000,AUC increased by less than 1 ％.At this point maintaining the same sample size while increasing the proportion of difficult samples,AUC increased by 0.4％.The results of evaluation parameters of target detection showed that the recall rate of each test group was 73.6％,79.8％,79.5％,79.8％ and 83.3％,respectively,and the differences were statistically significant (x2 =71.936,P＜0.01).Among them,the recall rates of test group two,three and four were higher than that of test group one,and the differences were statistically significant (x2 =25.960,23.492 and 25.960,all P＜0.006 25),and the recall rate of test group five was higher than those of test group one,two,three and four,and the differences were statistically significant (x2=67.361,9.899,11.527 and 9.899;all P＜0.006 25).In addition,the precision rates of test group one,two,three,four and five were 87.9％,85.3％,90.2％,91.4％ and 89.2％,respectively,and the difference was statistically significant (x2=48.194,P＜0.01).The precision rates of test group three and five were higher than that of test group two,and the differences were statistically significant (x2 =24.508 and 15.223,both P＜0.006 25),and the precision rate of test group four was higher than those of test group one and two,and the differences were statistically significant (x2=13.524 and 39.120,both P＜0.006 25).As samples size and training difficulty increased,the values of F1-score and mean average precision increased steadily.Conclusions This study initially constructed a computer-assisted polyp detection system under colonoscopy.Currently the maximum sensitivity reached 93.5％,and the maximum recall rate reached 83.3％.Increasing the training set size may improve the polyp detection result to a certain degree,however it will reach a bottleneck.At this time,increasing the training difficulty can further improve the detection scores,especially the recall rate.

Objective:To investigate the effect of decompression of optic nerve canal for traumatic optic neuropathy (TON) via lateral supraorbital approach.Methods:A retrospective case series study was performed to analyze clinical data of 23 TON patients admitted to First People's Hospital of Huzhou from December 2013 to June 2019. There were 16 males and 7 females, aged 17-51 years [(34.3±2.2)years]. Degree of visual impairment included count fingers in 4 patients, hand motion in 4, light perception in 9 and loss of light perception in 6. Visual evoked potential examination (VEP) was performed in 15 patients before surgery. The amplitude of P100 completely disappeared in 5 patients, and the amplitude of P100 was lower than the lower limit of normal value and the latency prolonged in 10 patients. The time from injury to operation was 3 h-14 days [(3.3±0.6)days]. All patients underwent decompression of optic nerve canal via supralateral orbital approach, and dural repair was performed simultaneously in 11 patients with dural rupture. Intraoperative fractures and meningeal tears, duration of operation, blood loss, and hospitalization duration were recorded. Combined with the classical visual acuity improvement assessment method and the World Health Organization (WHO) low vision and blind grading standard, visual acuity was compared before operation, at 10 days and 3 months after operation. Glasgow Coma Scale (GCS) was used to evaluate patients' state of consciousness in the course of the disease. Glasgow Outcome Scale (GOS) was used to evaluate the prognosis. Incidence of complications was observed as well.Results:All patients were followed up for 12-16 weeks [(13.5±2.4)weeks]. Intraoperative microscopic exploration revealed that all patients had optic nerve canal fracture, 3 patients had frontal fracture with dural rupture, and 8 patients had ethmoid bone fragment with anterior skull base dural rupture. The duration of operation was 108.5-224.3 minutes [(151.8±30.2)minutes], including (32.5±8.4)minutes for craniotomy. The intraoperative blood loss was 90.5-165.3 ml [(121.3±15.5)ml]. The hospitalization was 14-26 days [(19.7±3.4)days]. The visual acuity of 13 patients (57%) improved and 5 patients (39%) relieved from blindness 10 days after operation, showing significant difference compared with the preoperation ( P<0.05). The visual acuity of 17 patients (74%) improved and 9 patients (39%) relieved from blindness at 3 months after operation. There was significant difference in visual acuity examined between 10 days and 3 months after operation ( P<0.05). Six patients were invalid, and 4 of them had no light perception before operation and the amplitude of VEP examination completely disappeared. All patients had GCS of 15 when left the hospital and GOS of 5 at 3 months after operation. One patient had cerebrospinal fluid rhinorrhea and healed after 7 days of supine position. No secondary hematoma, epilepsy or intracranial infection occurred during follow-up. Conclusion:Optic canal decompression via the lateral supraorbital approach can improve visual acuity in early stage and increase the rate of out of blindness, with low postoperative complications and satisfactory functional recovery, which is worthy of clinical application.

Objective:To evaluate the safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy.Methods:This prospective, multi-center, single-arm study was initiated by the Affiliated Cancer Hospital of Zhengzhou University in June 2021 (CRAFT Study, NCT05282563). Participating institutions included Nanyang Central Hospital, Zhumadian Central Hospital, Luoyang Central Hospital, First Affiliated Hospital of Henan Polytechnic University, First Affiliated Hospital of Henan University, Luohe Central Hospital, the People's Hospital of Hebi, First People's Hospital of Shangqiu, Anyang Tumor Hospital, First People's Hospital of Pingdingshan, and Zhengzhou Central Hospital Affiliated to Zhengzhou University. Inclusion criteria were as follows: (1) gastric adenocarcinoma confirmed by preoperative gastroscopy;(2) preoperative imaging assessment indicated that R0 resection was feasible; (3) preoperative assessment showed no contraindications to surgery;(4) esophagojejunostomy planned during the procedure; (5) patients volunteered to participate in this study and gave their written informed consent; (6) ECOG score 0–1; and (7) ASA score I–III. Exclusion criteria were as follows: (1) history of upper abdominal surgery (except laparoscopic cholecystectomy);(2) history of gastric surgery (except endoscopic submucosal dissection and endoscopic mucosal resection); (3) pregnancy or lactation;(4) emergency surgery for gastric cancer-related complications (perforation, hemorrhage, obstruction); (5) other malignant tumors within 5 years or coexisting malignant tumors;(6) arterial embolism within 6 months, such as angina pectoris, myocardial infarction, and cerebrovascular accident; and (7) comorbidities or mental health abnormalities that could affect patients' participation in the study. Patients were eliminated from the study if: (1) radical gastrectomy could not be completed; (2) end-to-side esophagojejunal anastomosis was not performed during the procedure; or (3) esophagojejunal anastomosis reinforcement was not possible. Double and a half layered esophagojejunal anastomosis was performed as follows: (1) Open surgery: the full thickness of the anastomosis is continuously sutured, followed by embedding the seromuscular layer with barbed or 3-0 absorbable sutures. The anastomosis is sutured with an average of six to eight stitches. (2) Laparoscopic surgery: the anastomosis is strengthened by counterclockwise full-layer sutures. Once the anastomosis has been sutured to the right posterior aspect of the anastomosis, the jejunum stump is pulled to the right and the anastomosis turned over to continue to complete reinforcement of the posterior wall. The suture interval is approximately 5 mm. After completing the full-thickness suture, the anastomosis is embedded in the seromuscular layer. Relevant data of patients who had undergone radical gastrectomy in the above 12 centers from June 2021 were collected and analyzed. The primary outcome was safety (e.g., postoperative complications, and treatment). Other studied variables included details of surgery (e.g., surgery time, intraoperative bleeding), postoperative recovery (postoperative time to passing flatus and oral intake, length of hospital stay), and follow-up conditions (quality of life as assessed by Visick scores).Result:[1] From June 2021 to September 2022,457 patients were enrolled, including 355 men and 102 women of median age 60.8±10.1 years and BMI 23.7±3.2 kg/m2. The tumors were located in the upper stomach in 294 patients, mid stomach in 139; and lower stomach in 24. The surgical procedures comprised 48 proximal gastrectomies and 409 total gastrectomies. Neoadjuvant chemotherapy was administered to 85 patients. Other organs were resected in 85 patients. The maximum tumor diameter was 4.3±2.2 cm, number of excised lymph nodes 28.3±15.2, and number of positive lymph nodes five (range one to four. As to pathological stage,83 patients had Stage I disease, 128 Stage II, 237 Stage III, and nine Stage IV. [2] The studied surgery-related variables were as follows: The operation was successfully completed in all patients, 352 via a transabdominal approach, 25 via a transhiatus approach, and 80 via a transthoracoabdominal approach. The whole procedure was performed laparoscopically in 53 patients (11.6%), 189 (41.4%) underwent laparoscopic-assisted surgery, and 215 (47.0%) underwent open surgery. The median intraoperative blood loss was 200 (range, 10–1 350) mL, and the operating time 215.6±66.7 minutes. The anastomotic reinforcement time was 2 (7.3±3.9) minutes for laparoscopic-assisted surgery, 17.6±1.7 minutes for total laparoscopy, and 6.0±1.2 minutes for open surgery. [3] The studied postoperative variables were as follows: The median time to postoperative passage of flatus was 3.1±1.1 days and the postoperative gastrointestinal angiography time 6 (range, 4–13) days. The median time to postoperative oral intake was 7 (range, 2–14) days, and the postoperative hospitalization time 15.8±6.7 days. [4] The safety-related variables were as follows: In total, there were 184 (40.3%) postoperative complications. These comprised esophagojejunal anastomosis complications in 10 patients (2.2%), four (0.9%) being anastomotic leakage (including two cases of subclinical leakage and two of clinical leakage; all resolved with conservative treatment); and six patients (1.3%) with anastomotic stenosis (two who underwent endoscopic balloon dilation 21 and 46 days after surgery, the others improved after a change in diet). There was no anastomotic bleeding. Non-anastomotic complications occurred in 174 patients (38.1%). All patients attended for follow-up at least once, the median follow-up time being 10 (3–18) months. Visick grades were as follows: Class I, 89.1% (407/457); Class II, 7.9% (36/457); Class III, 2.6% (12/457); and Class IV 0.4% (2/457).Conclusion:Double and a half layered esophagojejunal anastomosis in radical gastrectomy is safe and feasible.