Purpose To investigate the gene expression and significance ofβ-catenin, Cyclin D1 and Notch1 in primary breast cancer stem cells ( BCSC) and matched lymph node metastasis stem cells. Methods 30 cases of breast invasive ductal carcinoma and matched metastasis lymph nodes were made into single cell suspensions, then BCSC were separated from them by immunomagnetic sor-ting. β-catenin, Cyclin D1 and Notch1 gene expressions of Wnt, Notch signaling pathway were detected by real time PCR. ResultsThe expression of β-catenin in primary BCSC and matched lymph nodes metastasis stem cells had statistically no differences ( P >0.05), while the expression of Cyclin D1 and Notch1 in matched lymph nodes metastasis stem cells were significantly higher than the expression in primary BCSC (P<0.01, respectively). Conclusion Compared with the primary cancer stem cells, Cyclin D1 and Notch1 activation in metastasis cancer stem cells are in higher level, which leades to a higher capability of invasion and metastasis, which may be a new therapeutic target.

Aim: To study the synthesis and anti-inflammatory activity of p-(sulfamyl) benzylidene-linked hetero-cyclic ketone derivatives. Methods: A series of p-(sulfamyl) benzylidene-linked heterocyclic ketone derivatives were synthesized. Anti-inflammatory activity was evaluated against xylene-induced ear oedema in mice and against carrageenan-induced paw oedema in rats. Gastrointestinal side effects in the rats were also examined after continu-ous introgastric administration of these compounds once daily for 7 days. Results: Twelve compounds( LHZ-101-LHZ-112) were synthesized and their structures were confirmed by IR, ~1H NMR, MS and elemental analysis. LHZ-105, LHZ-106 and LHZ-111 exhibited marked anti-inflammatory activity in xylene-induced mice ear swelling model. LHZ-106 and LHZ-111 showed significant anti-inflammatory activity in carrageenan-induced rat paw ede-ma model. LHZ-105, LHZ-106 and LHZ-111 had less gastrointestinal side effects than diclofenac sodium and CI-1004. Conclusion: These results suggest that some of these compounds have the potential for anti-inflammatory activity with few gastrointestinal side effects.

Objective:To investigate the risk factors affecting the occurrence of perioperative complications in patients with locally progressive gastric cancer undergoing radical gastric cancer treatment.Methods:The clinical data of 129 patients with locally progressive gastric cancer from January 2017 to December 2019 in Shaanxi Provincial People′s Hospital were retrospectively analyzed, including 98 males and 31 females, with an age ranged from 27 to 79 years and a mean age of (60.61±10.00) years. The postoperative complications of 129 patients with gastric cancer were firstly counted, and then the relationship between clinical data such as patients′ general condition, intraoperative status and pathological indexes and the occurrence of perioperative complications was analyzed by using univariate analysis, and significant factors were included in the logistic regression model for multifactor analysis to study the independent risk factors for the occurrence of perioperative complications.Results:Of the 129 patients, 25 cases (19.38%) had postoperative complications, including 10 cases (7.75%) with Clavien-Dindo classification combined with grade Ⅲ or higher complications. The results of univariate analysis suggested ACCI score >4 (30.76% vs 68.00%, χ2=11.86, P=0.001), body mass index ≥25 kg/m 2 (24.03% vs 60.00%, χ2=12.18, P=0.001), and preoperative hypoproteinemia (17.30% vs 36.00%, χ2=4.25, P=0.039), vascular cancer embolism (14.42% vs 40.00%, χ2=7.70, P=0.006), operative time ≥ 400 min (26.92% vs 52.00%, χ2=5.84, P=0.016), intraoperative bleeding ≥ 400 mL (13.46% vs 44.00%, χ2=12.03, P=0.001) were risk factors for the development of perioperative complications in patients with locally progressive gastric cancer. Multifactorial analysis showed that ACCI score >4, body mass index ≥25 kg/m 2, preoperative hypoproteinemia, vascular cancer embolism, and intraoperative bleeding ≥400 mL were independent risk factors for the occurrence of perioperative complications in patients with locally progressive gastric cancer ( P<0.05). Conclusions:The occurrence of perioperative complications in locally progressive gastric cancer hands was closely associated with ACCI score, body mass index, preoperative hypoproteinemia, vascular cancer embolism and intraoperative bleeding. ACCI score is expected to be a predictor of the occurrence of perioperative complications in patients with locally progressive gastric cancer.

Objective:To compare surgery-related indicators, patient recovery status, perioperative complications and risk factors affecting the occurrence of postoperative grade Ⅲ or higher complications in patients undergoing laparoscopic gastric mesenchymal tumor surgery with different visceral fat areas.Methods:Clinical data of 116 patients with gastric interstitial tumor in Shaanxi Provincial People′s Hospital from April 2014 to June 2020 were retrospectively analyzed, including 44 male patients and 72 female patients, with patient aged from 25 to 88 years old and the mean age was (61.8±10.7) years, including 54 patients in the high VFA group and 62 patients in the low VFA group. SPSS 23.0 was used for statistical analysis, and t-test and χ2 test were applied to compare and analyze the patients′ surgery-related indexes, postoperative recovery status, complications within 30 d after surgery and differences in Clavien-Dindo classification of complications, while univariate and multifactorial analyses were used to study the factors affecting the occurrence of postoperative grade Ⅲ or higher complications. Results:Patients in the high VFA group had a higher body mass index than in the low VFA group, and the difference was statistically significant ( t=4.48, P<0.001); patients in the high VFA group had longer operative time ( t=2.88, P=0.005), more intraoperative bleeding ( t=2.17, P=0.032), longer period of fasting ( t=2.73, P=0.008), longer time for defecation ( t=4.46, P<0.001) and bowel movement ( t=4.62, P<0.001), and longer postoperative hospital stay ( t=3.43) compared with those in the low VFA group ( t=2.73, P=0.001), prolonged defecation ( t=4.46), prolonged bowel movement ( t=4.62), and prolonged postoperative hospitalization ( t=3.43), with statistically significant differences ( P<0.05); the incidence of postoperative complications was significantly higher in the high VFA group (31.4%) compared with the low VFA group (14.5%) ( χ2=4.78, P=0.029); among them, the incidence of postoperative pulmonary infection was significantly higher in patients in the high VFA group (12.9%) compared with those in the low VFA group (1.6%), and the difference between them was statistically significant ( χ2=4.16, P<0.05); while the differences in postoperative incision-related complications, anastomotic fistula, lower limb venous thrombosis, and intestinal obstruction were not statistically significant ( P>0.05). The incidence of postoperative complications above grade Ⅲ of the Clavien-Dindo complication classification was significantly higher in patients in the high VFA group (16.7%) compared with those in the low VFA group (4.8%), and the difference between the two was statistically significant ( χ2=4.35, P<0.05); univariate analysis revealed that operative time ≥300 min and increased VFA were the risk factors for postoperative grade Ⅲ or higher complications, while VFA was not an independent risk factor. Conclusion:Larger visceral fat area increases the difficulty of laparoscopic gastric mesenchymal tumor surgery operation, and also affects patients′ postoperative recovery, leading to increased postoperative complications, but VFA is not an independent risk factor affecting the occurrence of postoperative grade Ⅲ or higher complications in patients with gastric mesenchymal tumor.

Objective To evaluate the result of laparoscopic pancreaticoduodenectomy (LPD).Methods We retrospectively analyzed the perioperative clinical data of 111 consecutive LPD procedures performed from Jan 2015 to Aug 2018 at Department of General Surgery,the Affiliated Hospital of Xuzhou Medical University.Results Of the 111 patients undergoing laparoscopic procedure,24 patients (21.6％) had abdominal surgery history.The mean operative time was (360.9 ± 108.9)minutes.The mean blood loss was (270.9 ± 184.9)m1.The mean operative time of pancreatojejunostomy and choledochojejunostomy was (46.2 ± 11.6) minutes and (19.0±7.2) minutes,respectively.The mean postoperative hospital stay was (14.9 ± 4.7) days.The rate of pancreatic fistula grade B was 6.3％ and pancreatic fistula grade A was 20.7％.The rate of bile leakage was 1.8％.Second surgical operation was necessary for 5 cases (4.5％),delayed postoperative hemorrhage occurred in 2 cases (1.8％).The mean number of lymph nodes harvested was(14.2 ± 7.9) and the positive rate number was (0.9 ± 1.8).Conclusions LPD improves the operation quality,reduces intraoperative hemorrhage and accelerates the postoperative recovery.

Objective:To explore and analyze the reliability and safety of sham feeding in facilitating the recovery of gastrointestinal function after laparoscopic appendectomy (LA), by using a new device, the Artificial Intelligence Bowel Tone Monitoring System.Methods:The data of 100 cases in Shaanxi Provincial People′s Hospital from Dec. 2020 to Sep. 2022 with acute appendicitis operated by LA who met the inclusion criteria. In this prospective study, participants were divided by random number table into a control group and an experimental group, with 50 cases in each group. The control group performed routine postoperative LA care, and the experimental group performed routine postoperative LA care and sham-feeding state care. The age, gender, recovery time of postoperative bowel sounds, time of first postoperative anal discharge, postoperative nausea and vomiting, abdominal distention, dry mouth and halitosis, and postoperative abdominal pain and other complications were recorded. GraphPad Prism 9.0 and SPSS 22.0 software were adopted to conduct data organization and analysis.Results:There were 100 valid cases in this trial. There were no statistical differences between the two groups in terms of gender, age, duration of surgery, abdominal pain and other symptoms ( P>0.05). The recovery time of bowel sounds after surgery was (8.92±0.56) h in the experimental group and (10.55±0.88) h in the control group, which was statistically significant ( t=10.99, P<0.0001); the recovery time of bowel sounds after surgery was (20.10±0.50) h in the experimental group and (20.96±0.59) h in the control group. There was a statistically significant difference between the two groups ( t=7.84, P<0.0001); there was a statistically significant difference between the experimental group (22%) and the control group (42%) for postoperative nausea and vomiting ( χ2=4.60, P=0.032); there was a statistically significant difference between the experimental group (16%) and the control group (52%) for postoperative abdominal distension ( χ2= There was a statistical difference between the experimental group (40%) and the control group (68%) ( χ2=7.89, P=0.005). The number of hospitalization days in the control group was (11.40±2.47) days and the days in the experimental group was (9.30±2.01) d, the difference between the two groups was statistically significant ( t=4.65, P<0.001); the hospitalization cost in the control group was (27 270.11±2 645.30) yuan and the cost in the experimental group was (23 669.68±2 841.28) yuan, the difference between the two groups was statistically significant ( t=6.56, P<0.001). Conclusion:To a certain extent, sham feeding can accelerate the recovery of gastrointestinal function in patients after LA, reduce the common postoperative discomfort, length of stay and hospital costs of patients.

Objective:To investigate the safety and efficacy of using bio-artificial dura mater to wrap around skeletonized hepatic artery during pancreatoduodenectomy in the prevention of gastroduodenal artery(GDA)stump related delayed bleeding.Methods:Clinical data were collected from 45 patients undergoing the bio-artificial dura mater wrapping skeletonized hepatic artery during pancreatoduodenectomy from Oct 2022 to Apr 2023 at Department of General Surgery, the Affiliated Hospital of Xuzhou Medical University.Results:Among the 45 patients, the bio-artificial dura mater was used to completely wrap the GDA stump and part of the common hepatic artery and the proper hepatic artery. The mean operative time was (308.1±93.1) min, the mean wrapping artery time was (18.7±7.5) min. Clinically relevant postoperative grade B pancreatic fistula (CR-POPF) occurred in 6 cases (13.3%), and intra-abdominal infection in 2 cases (4.4%).The rate of bile leakage was 2.2%.There were no second surgical operation, nor perioperative death. Postoperative delayed bleeding occurred in one case (2.2%) on the right hepatic artery branch near the hepatic portal. No pseudoaneurysm formation, nor bleeding occurring in any of the arteries wrapped by bio-artificial dura mater (including the GDA stump) after PD. There were no postoperative hepatic artery wrapping complications, such as hepatic artery stenosis, mesh-associated fluid accumulation and infection.Conclusion:Bio-artificial dura mater wrapping skeletonized hepatic artery technique in the process of pancreaticoduodenectomy can reduce the risk of delayed bleeding due to erosion of GDA stumps in case of post-PD pancreatic fistula.

Objective:To assess the clinical outcome of the novel computer assisted reduction malarplasty using angled double L-shaped osteotomies.Methods:Retrospective analysis of the 35 female patients who received reduction malarplasty surgery during June 2014 to April 2019 was conducted. Patients were divided into the conventional surgery group (9 cases) and the computer assisted surgery group (26 cases) based on their personal will. For the conventional surgery group, the zygomatic arch was repositioned inwardly after L-shaped osteotomy, and was rigidly fixed with miniplates and screws. The computer assisted reduction malarplasty was as follows: computer assisted angled double L-shaped osteotomies with surgical guide was performed intraorally, and the pre-bent titanium was used to setback the resected zygoma bone, which was then fixed with titanium miniplates and screws. Operation time, patients’ satisfaction (3-month follow-up) and postoperative complications (asymmetry and bone nonunion) were recorded and assessed. CT scans were performed to compare the preoperative design and 3-month postoperative follow-up for the computer assisted patient group. For statistical analysis, independent sample t test was used to analyze operation time of the 2 groups and chi-square test was used to analyze the data of patients’ satisfaction and asymmetry occurrence. P<0.05 was considered as statistically significant. Results:The mean operation time was (85.1 ± 17.8) min during computer assisted surgery versus (62.2±11.7) min during conventional surgery. The difference between the two groups was statistically significant ( t=3.53, P=0.020). Neither group showed noticeable resected bone shifting or soft tissue drooping. One patient in the conventional surgery group had bone nonunion on the right zygoma and partial absorption of the left zygomatic bone. The incidence of asymmetry in the computer-assisted group was 3.8% (1/26, surgical correction was not required), and 33.3% in the conventional surgery group (3/9, one patient required surgical correction). There was a statistically significant difference between the two groups ( χ2=6.179, P=0.046). Patients’ satisfaction in the computer-assisted group was 100% (26/26), and 78% (7/9) in the conventional surgery group ( χ2=7.929, P=0.019). Comparisons between the postoperative CT and preoperative simulation CT images showed that the position deviation of the resected bones was (0.21 ± 0.19) mm. Conclusions:In the present study, improved precision of zygomatic bone resection and bone setback was achieved in reduction malarplasty by using the angled double L-shaped osteotomies with computer assistance. Moreover, complication occurrences (asymmetry, bone nonunion etc.) were significantly decreased. Also, patients’ expectation was better achieved with this method.

Objective:To assess the clinical outcome of the novel computer assisted reduction malarplasty using angled double L-shaped osteotomies.Methods:Retrospective analysis of the 35 female patients who received reduction malarplasty surgery during June 2014 to April 2019 was conducted. Patients were divided into the conventional surgery group (9 cases) and the computer assisted surgery group (26 cases) based on their personal will. For the conventional surgery group, the zygomatic arch was repositioned inwardly after L-shaped osteotomy, and was rigidly fixed with miniplates and screws. The computer assisted reduction malarplasty was as follows: computer assisted angled double L-shaped osteotomies with surgical guide was performed intraorally, and the pre-bent titanium was used to setback the resected zygoma bone, which was then fixed with titanium miniplates and screws. Operation time, patients’ satisfaction (3-month follow-up) and postoperative complications (asymmetry and bone nonunion) were recorded and assessed. CT scans were performed to compare the preoperative design and 3-month postoperative follow-up for the computer assisted patient group. For statistical analysis, independent sample t test was used to analyze operation time of the 2 groups and chi-square test was used to analyze the data of patients’ satisfaction and asymmetry occurrence. P<0.05 was considered as statistically significant. Results:The mean operation time was (85.1 ± 17.8) min during computer assisted surgery versus (62.2±11.7) min during conventional surgery. The difference between the two groups was statistically significant ( t=3.53, P=0.020). Neither group showed noticeable resected bone shifting or soft tissue drooping. One patient in the conventional surgery group had bone nonunion on the right zygoma and partial absorption of the left zygomatic bone. The incidence of asymmetry in the computer-assisted group was 3.8% (1/26, surgical correction was not required), and 33.3% in the conventional surgery group (3/9, one patient required surgical correction). There was a statistically significant difference between the two groups ( χ2=6.179, P=0.046). Patients’ satisfaction in the computer-assisted group was 100% (26/26), and 78% (7/9) in the conventional surgery group ( χ2=7.929, P=0.019). Comparisons between the postoperative CT and preoperative simulation CT images showed that the position deviation of the resected bones was (0.21 ± 0.19) mm. Conclusions:In the present study, improved precision of zygomatic bone resection and bone setback was achieved in reduction malarplasty by using the angled double L-shaped osteotomies with computer assistance. Moreover, complication occurrences (asymmetry, bone nonunion etc.) were significantly decreased. Also, patients’ expectation was better achieved with this method.

Objective:To find out whether surgeon's proficiency in laparoscopic gastrectomy helps to get over the learning curve of laparoscopic pancreaticoduodenectomy (LPD) more quickly.Methods:From January 2015 to October 2016, the clinical and perioperative data of 41 consecutive patients who underwent LPD at the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The learning curves were evaluated using the CUSUMOT method and RA-CUSUM method.Results:Of 41 patients, 25 were males and 16 were females, with age ranging from 25.0 to 83.0 (60.6±13.7) years. These patients all successfully underwent LPD, with operation time Mean±SD being (456.3±85.9) min. There were 4 patients (9.8%) who developed biochemical fistula and 4 patients (9.8%) grade B pancreatic fistula. There was no grade C pancreatic fistula after operation. There were 10 patients who developed postoperative complications ≥ Clavien-Dindo grade III (24.39%) and 1 died. The data of the CUSUMOT method showed the learning curve to be over after the 33rd patient and the data of the RA-CUSUM method showed the learning curve to be over after the 31st patient.Conclusions:Laparoscopic gastrectomy helped surgeons to master the key techniques in LPD faster, and to get over the learning curve more safely and quickly.