Objective To enhance the understanding of hemophagocytic syndrome(HPS)by analyzing the clinical manifestations, diagnosis and therapy. Methods The clinical data of 12 patients with HPS were retrospectively collected in the People's Hospital of Jiangsu Province from 2000 to 2007. The relevant literature were reviewed. Results Twelve patients were diagnosed as secondary hemophagocytic syndrome most secondary to virus and bacteria infection. Some patients condition was associated with systemic lupus erythematosus or histiocytic necrotizing lympheadenitis. All of the 12 patients had high fever, abnormal liver function and showed a decrease in the number of blood cells in a short time. After antivirus and antibiotic treatment, 11 patients'condition were improved and 1 patient died. Conclusion Hemophagocytic syndrome is not a common clinical condition but with poor prognosis. When patient presents with fever without apparent reasons and pancytopenia, bone marrow examination should be done and sometimes repeated bone marrow examinations are needed. The diagnosis of secondary haemophagocytic syndrome needs multidisciplineary cooperation. Aggressive diagnostic procedures are needed to clarify the diagnosis and prompt treatments are warranted to improve prognosis.

Objective To investigate the safety, feasibility and results of laparoscopic assisted distal radical gastrectomy for gastric cancer. Methods Twenty-three cases of gastric cancer were subjected to laparoscopic assisted distal radical gastrectomy, D_(1+α)/D_(1+β) lymphadenectomy on 3 cases and D_2 lymphadenectomy on 20 cases. All cases received Billroth I reconstruction. Results Laparoscopic assisted distal radical gastrectomy was carried out in all cases successfully. The mean operative time was (205 ±38 )min, mean blood loss was (105 ± 66) ml and mean number of lymph nodes dissected was 19.7 ± 6.2 each case. The mean postoperative time of recovery of bowel function was (3.5 ±1.2) d,mean postoperative time of liquid intake was (4.9 ±0.9) d and mean hospitalization was (10.2 ± 2.7) d. No postoperative death or anastomotic fistula was found. Postoperative upper gastrointestinal bleeding occurred in 1 case and was cured by conservative treatment. Follow-up for 1-12 months revealed no recurrence or metastasis. Conclusions Laparoscopic assisted distal radical gastrectomy is a safe and feasible procedure with satisfactory short-term outcomes.Moreover,the short-term outcomes may be improved if the patients are treated under the notion of fast track surgery.

Objective To investigate the effects of melatonin on choline acetyltransferase (ChAT) in rat hippocampus after isoflurane anesthesia. Methods Sixty male SD rats weighing 390 - 440 g were randomized into 5 groups (n = 12 each): control group (group C), 1% isoflurane group (group Ⅰ), 1% isoflurane + melatonin group (group IM) , 2% isoflurane group (group J) and 2% isoflurane + melatonin group (group JM) . In IM and JM groups, melatonin 10 mg/kg was administered intraperitoneally once a day for 7 consecutive days, while equal volume of normal saline was given intraperitoneally instead of melatonin in C, I and J groups. Groups Ⅰ and IM inhaled 1% isoflurane and groups J and JM 2% isoflurane for 4 h on 7th day. All the rats underwent Morris water maze test on the day after anesthesia for assessment of learning and memory ability (escape latency and probe time) . The training test was performed 4 times a day for S days. Six rats randomly selected from each group were sacrificed the end of the test. The blood samples were collected for detection of plasma melatonin level by ELISA.The brain tissues were removed for determination of the expression and activity of ChAT in hippocampus by Western blot or colorimetric assay. The left rats were selected and sacrificed for determination of the number of ChAT positive neurons in hippocampal CA1 region and entate gyrus by immunofluorescence. Results The plasma melatonin level and expression and activity of ChAT were significantly lower in group I than in group C ( P ＜ 0.01) . The escape latency was significantly longer, the probe time was significantly shorter, and the plasma melatonin level and expression and activity of ChAT were significantly lower in group J than in group C ( P ＜ 0.05 or 0.01) . The escape latency was significantly shorter, the probe time was significantly longer, and the plasma melatonin level and expression and activity of ChAT were significantly higher in group IM than in group Ⅰ ( P ＜ 0.05 or 0.01). The escape latency was significantly shorter and the plasma melatonin level and ChAT activity were significantly higher in group JM than in group J ( P ＜ 0.05 or 0.01) . The results of immunofluorescent staining showed that the number of ChAT positive neurons in hippocampal CA1 region and dentate gyrus wag consistent with the changes in the measured ChAT expression. Conclusion Melatonin can reduce isoflurane-mediated inhibition of ChAT expression and activity and thus improve spatial memory impaired by isoflurane anesthesia in rats.

Background and purpose:Thyroid carcinoma is a common endocrine tumor with an incidence that has increased over recent decades. The aim of the present study was to investigate the effectiveness of carbon nano-par-ticles-labeled lymph nodes in neck dissection for papillary thyroid cancer (PTC), focusing on the protectiveness for the recurrent laryngeal nerve (RLN) and parathyroid glands.Methods:Forty-eight patients with PTC treated from Apr. to Aug. 2015 were randomly divided into two groups. Group A patients (24 patients) were treated with lobectomy/total thyroidectomy plus unilateral/bilateral central lymph node dissection by conventional meticulous capsular dissection technique; Group B patients (24 patients) were treated with the same surgical procedures as group A, 5 min after the injection of carbon nano-particles. The operative time, intra-operative blood loss, incidence of RLN injury, incidence of transient hypocalcemia, the number of total lymph nodes and the ratio of metastatic nodes were collected and analyzed. Results:For unilateral lobectomy, the number of lymph nodes in group B was signiifcantly greater than that in group A (P<0.05). For total thyroidectomy, the operative time, and the incidence of transient hypocalcemia in group B were both lower than those in group A (P<0.05), and the number of total lymph nodes was signiifcantly higher than that in group A (P<0.05). In group B, the ratio of metastatic nodes were 26.7% (unilateral) and 33.3% (bilateral) in stained lymphnodes, and 11.8% and 25.9% in non-stained lymph nodes.Conclusion:The carbon nano-particles-labeled lymph nodes in neck dissection could facilitate to protect parathyroids and increase the number of lymph nodes, especially in total thyroidectomy plus bilateral central lymph node dissection.

Objective:To investigate the clinical value of applying pain tolerance index(PTi) to guide multimodal analgesic regimen during the perioperative period in elderly hip fractures.Methods:A total of 100 elderly patients with hip fracture admitted to Fuyang People′s Hospital from April 2022 to April 2023 were selected as the study objects. The patients were underwent hip replacement and were divided into two groups according to the different analgesic methods used during the operation. The control group (50 cases) was given routine analgesia during the operation, and the experimental group (50 cases) was given multimode analgesia under the guidance of PTi during the operation. The anesthetic analgesic effect, hemodynamic indexes, inflammatory factors, visual analogue scale (VAS) score, hip function and analgesic drug application were compared between the two groups.Results:The excellent rate of anesthesia and analgesia in the experimental group was higher than that in the control group: 96.00%(48/50) vs. 82.00%(41/50), there was statistical difference ( χ2 = 5.00, P<0.05). The fluctuation ranges of mean arterial pressure (MAP) and heart rate (HR) at the beginning of operation, 30 min after operation and the end of operation in the experimental group were lower than those in the control group ( P<0.05). The serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the experimental groups were lower than those in the control group at 1 and 3 d after operation ( P<0.05). The scores of VAS at 24, 48 and 72 h after operation in the experimental group were lower than those in the control group ( P<0.05). The total scores of Harris questionnaire in the experimental group was higher than that in the control group at 6 weeks after operation: (85.93 ± 3.22) scores vs. (75.19 ± 4.18) scores, there was statistical difference ( P<0.05). The intraoperative dosage of propofol and sufentanil and the number of postoperative analgesic drugs in the experimental groups were lower than those in the control group: (430.61 ± 20.09) mg vs. (475.58 ± 23.17) mg, (33.24 ± 8.11) μg vs. (42.90 ± 9.64) μg, (1.54 ± 0.31) times vs. (2.07 ± 0.44) times, there were statistical differences ( P<0.05). The incidence of nausea and vomiting in the experimental group was lower than that in the control group: 2.00% (1/50) vs. 14.00% (7/50), there was statistical difference ( χ2 = 4.89, P<0.05). Conclusions:The application of PTi guided multimodal analgesia in elderly hip fracture surgery has a definite clinical effect, can maintain hemodynamic stability, reduce postoperative inflammatory stress and pain, promote hip joint function recovery, and has certain safety.

Objective To systematically evaluate the biomechanical recovery of drilled holes in the femur in SD rats.Methods Eighteen female SD rats were randomized into 3 even groups (n =6).Models of 2-mm drilled holes in bilateral femurs were established in groups A and B with 2 holes on each side while no drilling was performed in group C.Samples were harvested in group A at postoperative 4 weeks,in group B at postoperative 8 weeks while at both 4 and 8 weeks in group C.The samples were evaluated in terms of linear elasticity (compression test),viscoelasticity (relaxation and creep tests) and durability (fatigue failure test).Micro-CT scan was performed to measure the bone volume fraction (BV/TV) and bone mineral density (BMD) of new bone.Sirus red staining was performed to measure regeneration of type Ⅰ collagen of new bone.Results The elasticity modulus,maximum load,compression strength and conditional yield limit in groups A were significantly lower than those in group B which were also significantly lower than those in group C (P ＜ 0.05).At 7,200 s,the relaxation (14.56 ±0.69 MPa) and creep variation (11.37％ ± 0.70％) in group A were significantly higher than those in group B (11.06 0.63 MPa and 8.98％ ± 0.40％) which were also significantly higher than those in group C (6.99 ±0.56 MPa and 5.10％ ±0.23％) (P ＜ 0.05).At the constant amplitude loads from 20 N to 200 N,from 20 N to 300 N and from 20 N to 400 N,the recycling numbers in group A (6,044.3 ±879.7,4,093.3 ±628.5 and 1,919.3 ±847.5) were significantly lower than those in group B (10,192.3 ± 1,109.1,6,750.6 ± 818.0 and 3,376.6 ± 671.3) which were also significantly lower than those in group C (28,068.3 ±2,702.6,11,788.3 ± 1,141.6 and 5,296.3 ± 735.0) (P ＜ 0.05).By micro-CT scan,the BVT and BMD in group A were significantly lower than those in group B which were also significantly lower than those in group C (P ＜ 0.05).The sirus red staining showed the type Ⅰ collagen in the bone defect area was completely regenerated in group B.Conclusion Systematic biomechanical measurements may actually detect the characteristics of biomechanical recovery of bone holes in SD rats,enriching the basic research on the bone damage repairing progress.

Objective: To study the learning curve of laparoscopic pacreaticoduodenectomy (LPD) with a view to find an appropriate way to develop LPD step by step. Methods: 112 consecutive patients who completely underwent LPD in a single surgery center at the First People’s Hospital of Changzhou from December 2015 to February 2018 were retrospectively reviewed. By using both the cumulative sum (CUSUM) and the risk-adjusted CUSUM (RA-CUSUM) methods to analyze the perioperative data of these patients, the learning curve of LPD was studied in a more scientific way. Results: The learning curve could be divided into three phases: Phase 1, the initial period (the initial 45 patients); Phase 2, the enhancement period (the subsequent 31 patients); Phase 3, the maturation period (the remaining patients). For these 3 phases, the corresponding operative times were (448.4±75.0), (381.3±74.3), and (336.2±52.1) min, respectively (P<0.05). The intraoperative blood losses were (373.3±250.1), (332.3±211.6), and (265.3±253.2) ml, respectively (P<0.05). The times to oral intake were 6.0(5.0, 8.0), 5.0(3.0, 6.0), and 3.0(3.0, 5.0) days, respectively (P<0.05). The number of lymph nodes harvested were (10.0±7.0), (8.8±4.3), and (13.3±6.2), respectively (P<0.05). All these showed significant improvement through the 3 phases. On the other hand, the postoperative stays, the postoperative pancreatic fistula rates were also decreased. But these failed to reach statistical significance. Vascular reconstruction was carried out in the 48th patient in phase 2 of the study. Conclusions The initial phase of LPD passed after LPD for 46 patients, but the maturation phase occurred after LPD on 76 patients. Vascular reconstruction should be considered as passing through the learning phase rather than reaching the maturity phase. Adjustments made in the enhancement phase helped to get through the maturation phase earlier.

Objective: To compare the clinical application of three-dimensional laparoscopic pancreatoduodenectomy (3D-LPD) with that of two-dimensional laparoscopic pancreatoduodenectomy (2D-LPD), and to explore the safety and feasibility of 3D-LPD. Methods: A retrospective analysis was made from the data of 45 patients with 3D-LPD and 45 patients with 2D-LPD who underwent total laparoscopic pancreatoduodenectomy from March 2017 to August 2018 at Department of Hepato-Pancreato-Biliary Surgery, the First People′s Hospital of Changzhou.The differences of intraoperative conditions, postoperative complications and postoperative pathological findings between the two methods were compared.Measurement data were compared with independent sample t-test, enumeration data were statistically analyzed with Chi-square test or Fisher exact probability. Results: The operation time of 3D-LPD group was shorter than that of 2D-LPD group ((335±95) min vs. (419±113) min, t=-3.817, P=0.000), which mainly showed that the time of digestive tract reconstruction was reduced ((92±26) min vs. (131±46) min, t=-4.951, P=0.000). The intraoperative blood loss in the 3D-LPD group was significantly less than that in the 2D-LPD group ((242±124) ml vs. (350±176) ml, t=-3.365, P=0.001), and the perioperative blood transfusion in the 3D-LPD group was significantly less than that in the 2D-LPD group (χ²=4.444, P=0.035). Postoperative hospitalization days and ICU stay time were not significantly different between the two groups(both P>0.05). Postoperative complications such as pancreatic fistula, biliary fistula, postoperative bleeding, gastric emptying disorders, abdominal infection, were not significantly different between the two groups(all P>0.05). Conclusions The operation time of 3D-LPD is shorter than that of 2D-LPD, and the amount of bleeding is less. Short-term clinical data showed that, 3D-LPD is effective, safe and worth popularizing.