Objective To investigate the influence of previous abdominopelvic surgery on gynecological laparoscopic operation.Methods A retrospective analysis of 3 283 cases of gynecological diseases by laparoscopic operation patients in Peking University First Hospital from 2007 January to 2012 December,among them,719(21.90％) patients with previous abdominopelvic surgery history (study Group),2 564 (78.10％) patients have no history of abdominopelvic surgery (control group).Study group 719 patients,previous operation times:one time in 525 cases,194 cases were multiple; previous operation:185 cases of gynecological surgery,305 cases of obstetric surgery,108 cases of general surgery,and 121 complex surgery (include at least two kinds of surgery) ;previous operative approach:650 cases laparotomy and 69 cases laparoscopy.Compared two groups of patients with abdominopelvic adhesion and the gynecologic laparoscopic operation situation,analyzed the influence of previous abdominopelvic surgery on abdominopelvic adhesionon and gynecological laparoscopic operation.Results The incidence of abdominopelvic adhesion in the patients with previous abdominopelvic surgery was 51.2％ (368/719),which was significantly higher than that of 8.2％ (211/2 564) in patients without previous abdominopelvic surgery (P＜0.01).But the study group score (median 3) and the degree of abdominopelvic adhesion [mild 49.7％ (183/368),moderate 36.1％ (133/368),severe 14.1％ (52/368)] compared with the control group score (median 2) and degree [mild 55.0％(116/211),moderate 25.6％(54/211),and severe 19.4％(41/211)] were no statistical difference (P=0.930,P=0.684).Super-umbilical primary trocar site were chosen more common in patients with previous abdominopelvic surgery (23.1％,166/719) was significantly higher than that in the control group (3.3％,85/2 564; P＜0.01).And the rate of conversion to laparotomy was 0.6％ (4/719)significantly more than the control groups(0.l％,2/2 564; P=0.023).Compared with other groups,patients with gynecological or complex surgery or multiple operation history presented more severe abdominopelvic adhesion both in the score and degree (P＜0.01).The rate of super-umbilical primary trocar site,hospitalization time,operation time and bleeding during operation in patients with multiple operation history were significantly higher than those with single operation history (P＜0.05) ; the rate of blood transfusion,postoperative complication and conversion to laparotomy showed no statistical difference between the two groups (P＞0.05).Conclusion The laparoscopic operation could be carried out successfully and safely in patients with a history of various abdominopelvic operations,but the conversion rate increases,for patients with a history of multiple operation because of pelvic adhesion increases the difficulty of the laparoscopic operatio

Objective To investigate on the incidence of gynecological laparoscopic operation complications within ten years.Methods From January 2003 to December 2012,clinical data and the complications of 4 897 cases undergoing gynecological laparoscopic operation in First Hospital of Peking University were studied retrospectively.Those surgeries included 876 cases with hysterectomy,662 cases with myoectomy,3 266 cases with adnexa surgery,93 cases of diagnostic laparoscopy operation.Results The complications occurred in 29 cases,the incidence rate was 0.59％ (29/4 897).The Incidence rate in Hysterectomy group was 1.83％ (16/876),which was significantly higher than 0.60％ (4/662) in myoectomy group and 0.28％ (9/3 266) in adnexa surgery group.Twenty nine cases of complications were 14 cases with organ injures (48％,14/29),5 cases with hemorrhage complications (17％,5/29),8 cases with infectious complications (28％,8/29),2 cases with incisional hernia(7％,2/29).Conclusion The major complication of gynecological laparoscopic operation complication was organs injuries,which was associated with difficulty and scope of the operation.

Research based learning (RBL) is a brand new teaching mode implicated by Shanghai Jiaotong University School of Medicine specifically designed for clinical undergraduates.The nature of RBL is about exploring unknown knowledge and designing and executing comprehensive experiments.RBL aims at creating an open,active student participation,and close student-mentor interaction teaching mode.IBL includes literature study,research aim selection,experiment design and implementation,statistical analysis,results and conclusions,final report writing and defense of the report.Our experience indicates that RBL can substantially improve students' scientific logic and critical thinking and experimental skills,and develop the spirit of a team-player.This scientific training enables students to receive more comprehensive scientific training,facilitate their subsequent clinical research and practice,and assist them to participate in more international scientific exchanges.We propose that the RBL mode should be adopted for clinical student education in other universities.

Ischemia-reperfusion injury (IRI) is a pathophysiological process, which widely exists in organ transplantation and surgery. IRI is mainly manifested with hypoxia injury of organs or tissues during the ischemia period, which could be further aggravated after reperfusion. Ischemia-reperfusion induces tissue cell injury, releases damage-associated molecular pattern and further activates multiple immune cells via pattern recognition receptor, leading to aseptic inflammation and aggravating tissue injury. Cyclic guanosine monophosphate-adenosine monophosphate synthase (cGAS), as a critical member of pattern recognition receptor, could activate the stimulator of interferon genes (STING) signal pathway and play an important regulatory role in innate immune response. At present, increasing evidences have shown that cGAS-STING signal pathway plays a significant role in organ IRI. In this article, STING signaling pathway, its role and mechanism in IRI of different organs were reviewed, aiming to provide novel ideas for clinical interventions.

Objective:To explore the symptom management experience in young and middle-aged patients with home peritoneal dialysis.Methods:Using the descriptive phenomenological research method and purposive sampling method, 13 young and middle-aged peritoneal dialysis patients were selected for semi-structured interviews, and the interview data was analyzed and sorted out to extract themes.Results:A total of four themes were summarized, including difficulties in symptom management (lack of symptom management knowledge, insufficient symptom perception ability), effect of poor symptom management effectiveness (limited daily life behavior, weakened family roles, obstacles in returning to the workplace, withdrawal of social activities and increased economic burden), polarized symptom management coping strategies (positive and negative responses) and multifaceted symptom management needs (longing for new treatment methods, hoping for disease knowledge popularization and craving for social support in various aspects) .Conclusions:There are many obstacles and needs in the process of symptom self-management of young and middle-aged home peritoneal dialysis patients. It is suggested that medical staff should combine the characteristics and psychology of middle-aged and young peritoneal dialysis patients, implement targeted intervention measures, and improve their symptom management ability.

Objective To find the target of auranofin with the antibacterial activity against gramnegative bacteria and to investigate the effect of the combination of auranofin and vorinostat on the antibacterial activity against gram-negative bacteria.Methods The strains of E.coli lacking thioredoxin reductase (TrxR)was used to find the target gene.The potential synergies of the combination of auranofin and vorinostat for E.coli strain,A.baumannii strain,P.aeruginosa strain,K.pneumonia strain and muhidrug-resistant (MDR)A.baumannii strain were evaluated using susceptibility tests,micro-dilution checkerboard tests and time-kill studies.The genes related to Trx (trxA,trxB,trxC) and the gene expressed glutathione (gor) of E.coli BW25113 strains (WT) were separately knocked out to observe the effect of auranofin on minimum inhibitory concentration (MIC) and the time-kill kinetics of △trxC and △gor.Furthermore,the complemented strains (C-trxA,C-trxB,C-trxC,C-gor) were used to verify and define the genetic targets.Results According to the results of susceptibility tests,MICs of auranofin were 64 mg/L for E.coli strain BW25113 and K.pneumonia strain ATCC 43816,128 mg/L for P.aeruginosa strain PA14 and 32 mg/L for both A.baumannii strain ATCC 17978 and A.baumannii strain AB5075.However,MICs of vorinostat are 512 mg/L for all isolates.The fractional inhibitory concentration indexes (FICIs) of the combination of auranofin and vorinostat for E.coli strain BW25113,A.baumannii strain ATCC 17978,MDR A.baumannii strain AB5075,K.pneumonia starin ATCC 43816 and P.aeruginosa strain PAl4 were 0.313,0.375,0.375,0.375,and 0.375,respectively,with all values ＜ 0.5,which showed synergy.In susceptibility tests of knockout strains,MICs of auranofin for △trxC increased from 64 mg/L to 256 mg/L,decreased to 16 mg/L for △gor,and no changes for △trxA and △trxB.Auranofin showed the same antibacterial activities against the complemented strains (C-trxC,C-gor) and E.col BW25113,which decreased by about 1.8 lg colong formins units (CFU)/mL of bacterial counts.However,the antibacterial activity of auranofin was significantly reduced for △trxC,and decreased by ＜ 1 lg CFU/mL of bacterial counts.For Agor,bacterial counts decreased 4.6 lg CFU/mL,and the antibacterial activity markedly increased.Conclusions The potential target gene of auranofin against gram-negative bacteria could be trxC,which provides new ideas and methods for the clinical treatment of multidrug-resistant gram-negative bacteria.

Objective:To compare the efficacy of reduction and in situ intervertebral fusion fixation in the treatment of degenerative lumbar spondylolisthesis.Methods:A total of 182 patients (92 males and 90 females) with L 4 degenerative lumbar spondylolisthesis of Meyerding's classification of grade I and grade II, aged (62.6±6.8) years (range, 57-73 years), who underwent posterior L 4, 5 internal fixation and interbody fusion in the Department of Spinal Surgery, the Second Hospital of Shanxi Medical University, were retrospectively analyzed from January 2019 to December 2022. There were 105 cases of I-degree spondylolisthesis and 77 cases of II-degree spondylolisthesis. According to the operation method, the patients were divided into reduction intervertebral fusion fixation (reduction group) and in situ intervertebral fusion fixation group (in situ group). Imaging parameters such as lumber lordosis (LL), pelvic incidence (PI)-LL, L 3, 4 intervertebral space heights, fusion segment angle, and sagittal vertical axis (SVA) were measured on the pre- and post-surgical lumbar spine lateral radiographs. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) of low back pain were recorded before and after surgery. The differences in clinical and imaging parameters were compared between reduction and in situ fusion group. Results:All 182 patients successfully completed the surgery and were followed up for 12.0±2.4 months (range, 9-15 months). The LL of the reduction group before surgery, immediately after surgery, and at the last follow-up were 46.9°±7.1°, 57.2°±5.9°, 55.6°±5.5°, respectively, with statistically significant differences ( F=87.61, P<0.001), with immediate and final follow-up being smaller than those in the in situ fixation group. The LL of the in situ fixation group before surgery, immediately after surgery, and at the last follow-up were 47.8°±7.2°, 50.5°±7.0°, and 48.7°± 6.4°, respectively, with no statistically significant difference ( F=2.83, P=0.062). The immediate and final follow-up of LL in the reduction group was lower than those in the in situ fixation group ( P<0.05). The fusion segment angles of the reduction group before surgery, immediately after surgery, and at the last follow-up were 14.2°±5.1°, 23.2°±4.7°, 23.2°±4.7°, respectively, with statistically significant differences ( F=152.87, P<0.001), with immediate and final follow-up after surgery being greater than before surgery. The fusion segment angles of the in situ fixation group before surgery, immediately after surgery, and at the last follow-up were 15.4°±5.9°, 18.2°±5.5°, and 17.4°±5.1°, respectively, with statistically significant differences ( F=4.69, P=0.009), with immediate and final follow-up being greater than before surgery. The fusion segment angulation in the reduction group was greater than that in the in situ fixation group at both the immediate and final follow-up ( P<0.05). The SVA of the reduction group before surgery, immediately after surgery, and at the last follow-up were 16.9±18.2 mm, 9.5±12.0 mm, and 8.7±11.3 mm, respectively, with statistically significant differences ( F=11.32, P<0.001), with immediate and final follow-up being smaller than before surgery. The SVA of immediately after surgery and at the last follow-up were both smaller than before surgery. The SVA of the in situ fixation group before surgery, immediately after surgery, and at the last follow-up were 16.4±17.2 mm, 14.3±15.5 mm, and 13.8±15.0 mm, respectively, with no statistically significant difference ( F=0.57, P=0.576). The SVA of the reduction group at immediate and final follow-up was lower than that of the in situ fixation group ( P<0.05). Conclusion:Both reduction and in situ intervertebral fusion fixation can effectively relieve the clinical symptoms of patients. Fusion fixation after reduction can improve the angulation of fusion segments to form segmental kyphosis, which is more conducive to improving SVA.

Objective To preliminary explore the in vitro anti-inflammatory effects of Qinggan Tongyin based on serum pharmacology and network pharmacology.Methods The effects of the serum containing Qinggan Tongyin on the release of NO,cell necrosis factor-α(TNF-α),and interleukin-6(IL-6)in LPS-induced RAW264.7 cells were confirmed using serum pharmacology.UHPLC-MS/MS was used to determine the index components of Qinggan Tongyin.The possible targets and pathways of active components in Qinggan Tongyin for anti-inflammatory properties were predicted by using network pharmacology.Results The results of cellular assay showed that Qinggan Tongyin could dramatically lessen the levels of NO,TNF-α,and IL-6(P＜0.05,P＜0.01,P＜0.001).The higher contents of Qinggan Tongyin were phillyrin A,arctiin,chlorogenic acid,scutellarin,gallic acid,rosmarinic acid,paeoniflorin and phillyrin.A totsl of 215 intersection targets between 17 active components in Qinggan Tongyin and inflammation were obtained,and the 31 core targets were ALB,VEGFA,IL-6,TNF-α,etc..The primary targets can exhibit anti-inflammatory actions by regulating several signaling pathways,such as AGE-RAGE,PI3K-Akt,and MAPK signaling pathway.Conclusion Qinggan Tongyin exerts its anti-inflammatory effects with the characteristic of multiple components and multiple targets.

Objective To study the coordination and function of a laparoscopic assistant in laparoscopic pancreaticoduodenectomy (LPD).Methods A retrospective analysis was conducted on 101 patients who underwent LPD at the Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,from January 2014 to March 2017.The study aimed to study the coordination and function of a laparoscopic assistant.Results LPD was successfully completed in all the 101 patients.There was no conversion to open surgery.The operation time was (326.0 ± 55.6) min,and the resection time was (174.4 ± 42.5) min.The digestive tract reconstruction time was (101.0 ± 21.4) min.The time of pancreaticojejunostomy was (40.5 ± 8.7) min.The time of gastrointestinal anastomosis was:(26.3 ± 5.5) min.The time of biliary anastomosis was (24.4 ± 6.5) min.The intraoperative bleeding was (175.6 ± 41.1) ml.Postoperative pathological data showed that 27 patients (26.7％) had distal common bile duct cancer,23 patients (22.8％)ampullary carcinoma,39 patients (38.6％) duodenal papillary carcinoma,and 12 patients (11.9％) pancreatic ductal adenocarcinoma.The tumor diameter was (2.3 ± 1.3) cm,and the number of resected lymph nodes was (16.7 ±4.2).The number of positive lymph nodes was 1.3 ± 1.1.The length of postoperative hospital stay was 14.8 (8 ～ 29) d.Twenty-three patients developed postoperative pancreatic fistula,including 17 patients (16.8％) with a biochemical fistula,5 patients (5.0％) with a grade B pancreatic fistula,and 1 patient (1.0％) with a grade C pancreatic fistula.There were 2 patients (3.0％) with bile leakage,7 patients (6.9％) with intra-abdominal bleeding,4 patients (4.0％) with delayed gastric emptying,6 patients (5.9％) with abdominal infection,3 patients (3.0％) with pulmonary infection,2 patients (2.0％)with intestinal obstruction,3 patients (3.0％) required a repeated operation,and 1 patient (1.0％) with death in hospital within 30 days after surgery.Conclusions The laparoscopic assistant should have the perspective of "one axis,two sides and four regions" in LPD,and warn the operator to ensure the safety and fluency of the operation by clearly exposing important blood vessels and organs when performing the Kocher incision and when dissecting the key parts such as the dangerous triangle of the uncinate process.During anastomosis,the laparoscopic assistant should appropriately adjust the distance of vision,clearly reveal the surgical field of the anastomotic area,and help the surgeon in improving the precision of the suture and the quality of the anastomosis.

Purpose: Molecular residual disease (MRD) is a promising biomarker in colorectal cancer (CRC) for prognosis and guiding treatment, while the whole-exome sequencing (WES) based tumor-informed assay is standard for evaluating MRD based on circulating tumor DNA (ctDNA). In this study, we assessed the feasibility of a fixed-panel for evaluating MRD in CRC. Materials and Methods: Seventy-five patients with resectable stage I-III CRC were enrolled. Tumor tissues obtained by surgery, and preoperative and postoperative day 7 blood samples were collected. The ctDNA was evaluated using the tumor-agnostic and tumor-informed fixed assays, as well as the WES-based and panel-based personalized assays in randomly selected patients. Results: The tumor-informed fixed assay had a higher preoperative positive rate than the tumor-agnostic assay (73.3% vs. 57.3%). The preoperative ctDNA status failed to predict disease-free survival (DFS) in either of the fixed assays, while the tumor-informed fixed assay-determined postoperative ctDNA positivity was significantly associated with worse DFS (hazard ratio [HR], 20.74; 95% confidence interval [CI], 7.19 to 59.83; p < 0.001), which was an independent predictor by multivariable analysis (HR, 28.57; 95% CI, 7.10 to 114.9; p < 0.001). Sub-cohort analysis indicated the WES-based personalized assay had the highest preoperative positive rate (95.1%). The two personalized assays and the tumor-informed fixed assay demonstrated same results in postoperative landmark (HR, 26.34; 95% CI, 6.01 to 115.57; p < 0.001), outperforming the tumor-agnostic fixed panel (HR, 3.04; 95% CI, 0.94 to 9.89; p=0.052). Conclusion Our study confirmed the prognostic value of the ctDNA positivity at postoperative day 7 by the tumor-informed fixed panel. The tumor-informed fixed panel may be a cost-effective method to evaluate MRD, which warrants further studies in future.