Objective To explore the impact of nutritional risk on short-term clinical outcomes after laparoscope-assisted radical gastrectomy for gastric cancer.Methods The retrospective case-control study was conducted.The clinical data of 150 patients who underwent laparoscopic gastrectomy at the First Affiliated Hospital of Wenzhou Medical University between June 2014 and April 2016 were collected.According to nutritional risk screening 2002 (NRS 2002),42 and 108 patients were respectively divided into the nutritional risk group (NRS 2002 score ≥3) and non-nutritional risk group (NRS 2002 score ＜3).Laparoscope-assisted radical subtotal gastrectomy or total gastrectomy was performed based on tumor location.Observation indicators:(1) postoperative short-term clinical outcomes:postoperative complications,duration of postoperative hospital stay,hospital expenses,unplanned readmission within 30 days after discharging.Postoperative complications meant total complications within 30 days postoperatively,grade Ⅰ-Ⅴ of Clavien-Dindo grade was complication classification.Grade Ⅱ and above of Clavien-Dindo grade were analyzed in this research.(2) Risk factors analysis affecting occurrence of postoperative complications of patients.Measurement data with normal distribution were represented as x±s and analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (Qn) and analyzed using the Mann-Whitney U test.Categorical variables were described as number and percentage and analyzed by the chisquare test.Ranked data were analyzed by the Mann-Whitney U test.Univariate analysis was done by the chi-square test.P＜0.1 of univariate analysis was used to multivariate analysis.COX regression model in multivariate analysis was built using progressive condition method.Results (1) Postoperative short-term clinical outcomes:number of patients with total complications,number of patients with severe complications,duration of postoperative hospital stay,hospital expenses and number of patients with unplanned readmission within 30 days after discharging were 9,2,11 days (9 days,16 days),57 825 yuan (51 894 yuan,66 908 yuan),2 in the nutritional risk group and 16,3,11 days (9 days,13 days),55 067 yuan (49 395 yuan,62 423 yuan),8 in the non-nutritional risk group,respectively,with no statistically significant difference between the 2 groups (X2=0.952,0.010,Z=-1.133,-1.691,X2 =0.048,P＞0.05).Results of univariate analysis showed that age was a risk factor affecting incidence of complications after laparoscope-assisted radical gastrectomy for gastric cancer (X2 =4.468,P＜ 0.05).Results of multivariate analysis showed that preoperative hypoproteinemia was an independent risk factor affecting incidence of complications after laparoscope-assisted radical gastrectomy for gastric cancer (OR =2.797,95％ confidence interval:1.053-7.435,P＜0.05).Conclusion There is little poor impact of nutritional risk on short-term outcomes after laparoscope-assisted radical gastrectomy for gastric cancer,preoperative hypoproteinemia is an independent risk factor affecting occurrence of grade Ⅱ and above of postoperative complications.

ObjectiveTo summarize and review the clinical characteristics of congenital pulmonary lymphangiectasia with fetal bilateral pleural effusions.MethodsThe clinical data of a newborn diagnosed as congenital pulmonary lymphangiec-tasia with bilateral pleural effusions in Obstetrics and Gynecology Hospital, was summarized. The clinical, radiographic features, treatment and prognosis of this case are discussed in the context of the literature review.ResultsThe premature infants present-ed with rapid progression bilateral pleural effusions, respiratory distress, chylothorax, hypoalbuminemia and persistent pulmo-nary hypertension at birth. The pulmonary surfactant was given and mechanical ventilation was used for respiratory support. NO was inhaled, high-frequency mechanical ventilation was applied and albumin was repeatedly administered. After treatment for 3 months in the NICU, the patient was discharged. After 10 days, the patient was administered to the PICU with severe pneumo-nia, chronic lung disease, mechanical ventilation and anti-infection treatments were applied for 2 months. After living for six months, the baby died.ConclusionsCongenital pulmonary lymphangiectasia is extremely rare and prenatal diagnosis was dif-ifcult. The disease should be considered in patients presented with progressive dyspnea, interstitial emphysema after birth. Lung tissue biopsy and radioisotope scanning should be performed in time to get diagnosis.

Objective To understand the occurrence and the related risk factors of birth defects. Methods Descriptive analysis was conducted on birth detect surveillance in the infants during January 2008 to June 2014. Results A total of 777 cases of birth defect were detected in 73498 infants, and the incidence of birth defect was 1.06%. The 5 most common birth de-fects were congenital heart disease, multi ifnger (toe), hypospadias, cleft lip, and palate and deformity of external ear. Compared infants born with no birth defects, male, preterm, low birth weight, twin and multiple births and resident were statistically higher in infants with birth defects (P<0.05). The major risk factors of birth defects were the medication history, spontaneous abortion, gestational diabetes mellitus, and family history. Conclusions The incidence of birth defect can be reduced by providing good health care during pre-marriage and pregnant so as to decrease the occurrence of premature infants, twins and multiple births, and low birth weight as well as improving prenatal diagnosis and intensifying birth defects surveillance.

Objective To summarize the clinical characteristics of neonates with non-immune hydrops fetalis.Methods The clinical data of ten neonates with non-immune hydrops fetalis, who were admitted to the Department of Neonatology, Gynecology and Obstetrics Hospital of Fudan University between January 2012 and June 2014, were retrospectively studied.Prenatal characteristics, causes, clinical features and prognosis were explored and analyzed with descriptive statistical methods.Results (1) One of the ten neonates was diagnosed after birth presented with hydroderma and abdominal distension, and the rest ones were diagnosed antenatally.There were six males and four females, and eight premature and two term neonates with the average gestational age of (33.6±2.4) weeks and birth weight of(2 680±478) g.(2) The mean maternal age was (30.3 ±4.6) years.Two of the mothers had gestational diabetes mellitus and one had gestational diabetes mellitus complicating with hyperthyroidism.The blood types of all mothers were O and Rh(+).None of the mothers were tested for parvovirus B19 and no fetus was reported with abnormal chromosome karyotype in the five cases received fetal karyotype analysis.(3) The average gestational age at initial identification of hydrops fetalis by fetal ultrasound was (31.3 ± 2.4) weeks (25.1～37.0 weeks) among nine cases diagnosed prenatally.By ultrasound screening, there were seven cases with hydrothorax, six with seroperitoneum, five with polyhydramnios and four with hydroderm.(4) Two neonates had normal non-stress test results during labor, and eight were abnormal and suffered from severe neonatal asphyxia at birth and resuscitated by endotracheal intubation.Ten neonates had hydroderm, seven had hydrothorax, six had seroperitoneum and one had hydropericardium.One complicated with multiple malformations and one had chromosome abnormality.Four cases received thoracentesis and three had abdominal paracentesis after parturition.(5) Prognosis: One neonate survived and nine died among which six due to resuscitation failure in delivery room, two died one day after giving up treatment after one day, and one died due to treatment failure six months after birth.(6) The causes of hydrops fetalis were anemia (two cases) and congenital diaphragmatic hemangioma, recurrent atrial premature beat, Down's syndrome, congenital pulmonary lymphangiectasia, paroxysmal supraventricular tachycardia, placental chorioangioma, suspicious genetic syndrome and idiopathic (one for each).Conclusions The prognosis varies because of different etiology of non-immune hydrops fetalis.Neonates with hydrops fetalis might have a higher rate of asphyxia and mortality rate, and difficulties in resuscitation at birth.

Objective To evaluate the effect of astragaloside Ⅳ on postoperative cognitive function in aged rats.Methods Sixty healthy male Sprague-Dawley rats,aged 22 months,weighing 360-480 g,were divided into 4 groups(n=15 each)using a random number table:control group(group C),surgery group(group S),low-dose astragaloside Ⅳ group(group L-AGS)and high-dose astragaloside IV group(group H-AGS).At 3 days prior to surgery,astragaloside Ⅳ 20 and 40 mg/kg were injected intraperitoneally once a day in L-AGS and H-AGS groups,respectively.The equal volume of normal saline was given instead in C and S groups.The animals underwent splenectomy under anesthesia with 1.8% isoflurane in S,L-AGS and H-AGS groups.Five rats in each group were randomly sacrificed at 1 day after operation,the hippocampi were removed for determination of interleukin-1beta(IL-1β),tumor necrosis factor-alpha(TNF-α)and IL-6 contents(by enzyme-linked immunosorbent assay)and expression of activated caspase-3,Bax and Bcl-2(by Western blot).The left animals underwent Morris water maze test at 15 days after operation.Results Compared with group C,the escape latency was significantly prolonged,the frequency of crossing the original platform was reduced,the space exploration time was shortened,the expression of activated caspase-3 and Bax was up-regulated,the expression of Bcl-2 was down-regulated,and the IL-1β,TNF-α and IL-6 contents were increased after operation in group S(P<0.05).Compared with group S,the escape latency was significantly shortened,the frequency of crossing the original platform was increased,the space exploration time was prolonged,the expression of activated caspase-3 and Bax was down-regulated,the expression of Bcl-2 was up-regulated,and the IL-1β,TNF-α and IL-6 contents were decreased after operation in L-AGS and H-AGS groups(P<0.05).Compared with L-AGS,the escape latency was significantly shortened,the frequency of crossing the original platform was increased,the space exploration time was prolonged,and the TNF-α contents were decreased after operation in group H-AGS(P<0.05).Conclusion Astragaloside Ⅳ can improve the postoperative cognitive function in a dose-dependent manner in aged rats.

Objective:To observe the application of near-infrared autofluorescence imaging (NIRAF) technology combined with carbon nanoparticle (CNP) negative imaging in identification of parathyroid gland (PG) during thyroid carcinoma surgery.Methods:80 patients with thyroid cancer who underwent total thyroidectomy + central lymph node dissection performed by the same experienced physician team at the 960th Hospital of the PLA from Jan. to Mar. 2022 were prospectively included. Before operation, they were divided into two groups using random number table method before surgery: control group (40 cases) using CNP negative imaging, and experimental group (40 cases) using CNP negative imaging combined with NIRAF technique for intraoperative identification of PG. The gold standard for the identification of parathyroid glands was to compare the amount of intraoperative discovery retention misresection and transplantation of PG and the number of postoperative parathyroid hormone (PTH) and the number of complications in the two groups by immune colloidal gold technique. SPSS 25.0 software was used for statistical analysis.Results:All patients in the two groups were successfully operated and followed up. 137 149 PG were found and confirmed in the control group and the observation group, 108 132 PG were retained in situ and 29 17 PG were transplanted, the differences were statistically significant (all P <0.05) ; The number of A1 PG was 103 and 109, respectively. Among them, 84 102 were retained in situ and 19 7 were transplanted, the difference was statistically significant ( P <0.05) . There was no significant difference in the amount of A2 type PG and B type PG between the two groups ( P >0.05) . No A3 type PG was found in the two groups, and a total of 3 A3 types of PG were confirmed in postoperative pathological reports. There were no significant differences in misresection in the control group and the observation group, 5 and 2 PG were mistakenly cut, respectively (all P >0.05) . The PTH 1 day after surgery was 17.7 (5.6,30.4) pg/mL in the control group and 21.7 (12.8,38.3) pg/mL in the observation group, the difference was statistically significant ( P<0.05) . There were no significant differences in the levels of serum calcium and serum phosphorus 1 day after operation and PTH 1 month after surgery between the two groups (all P > 0.05) . Conclusion:Compared with CNP alone, combined with NIRAF technique can quickly and effectively identify PG, and PG can be better protected in situ and postoperative hypoparathyroidism can be reduced.

Robotic thyroidectomy (RT) system combines the advantages of the surgical robot and remote access thyroidectomy,provides the benefits of excellent three-dimensional visualization,stable operative view and improved surgical dexterity,has been applied in clinical practices for 10 years and proved to have comparable surgical safety and oncological completeness with traditional open operation,and provides smaller surgical injury (psychological and physical injury),better functional protection (including neck function,parathyroid glands and laryngeal nerve),and significantly higher cosmetic satisfaction.There are two mostly common used RT approaches,bilateral axillobreast approach (BABA) and transaxillary approach (TAA).Since surgeons accumulate more experience,the indications of RT have been expanded to differentiated thyroid cancer with tumor size between 2-4 cm with (or without) lateral neck lymph node metastases by far.To date,all related studies are nonrandomized or retrospective comparisons.It's necessary to launch multi-centers randomized studies and long term follow-up to offer higher evidence to boost the future application of RT.

Tertiary hyperparathyroidism is commonly observed in patients with long-standing chronic kidney disease (CKD) after renal transplantation and is characterized by the autonomous hypersecretion of PTH leading to hypercalcemia.The primary treatment is surgery.After the introduction of cinacalcet,both surgical and medical methods have been commonly performed to treat tertiary hyperparathyroidism.However,which treatment is more appropriate has not been fully demonstrated.In this paper,the author will systematically review the related research of surgical treatment and cinacalcet in the treatment of 3HPT,and summarize their respective therapeutic effects.

Objective:To explore any effect of on the limb and cardiopulmonary functioning of stroke survivors of combining new Bobath technique with cardiopulmonary rehabilitation.Methods:A total of 160 stroke survivors with limb disorders were randomly divided into an observation group and a control group, each of 80. Both groups were given routine rehabilitation and the new version of Bobath training, but the observation group was additionally provided with 12 weeks of cardiopulmonary rehabilitation. Before and after the treatment the limb functioning of both groups was evaluated along with their ability in the activities of daily living and the recovery of damaged nerve function, using the simplified Fugl-Meyer (FMA) motor function scoring, the modified Barthel index (MBI) and the Chinese stroke scale (CSS). Peak oxygen uptake (VO 2peak), peak metabolic equivalent (METpeak), peak heart rate (HRpeak) and anaerobic thresholds (ATs) were documented. Results:After the treatment the average FMA, MBI and CSS scores and cardiopulmonary indexes had improved significantly in both groups. All were then significantly better in the observation group than in the control group.Conclusions:Combining the new Bobath technique with cardiopulmonary rehabilitation can significantly improve the limb and cardiopulmonary functioning of stroke survivors, as well as their skill in the activities of daily living and the recovery of the damaged nerve functionality. This combination is therefore worthy of clinical promotion and application.

Objective:To evaluate the feasibility and safety of robotic thyroidectomy for treatment of thyroid benign tumor with diameter larger than 5cm.Methods:The clinical data of 36 patients (in the robot group) who received Da Vinci robot thyroid benign tumor surgery in the thyroid breast Surgery Department of the 960th Hospital of the PLA (Former Jinan Military General Hospital of PLA) from Jan. 2014 to Jun. 2019 were retrospectively analyzed, and compared with 48 patients (in the open group) who received open surgery in the same period.The operative time, intraoperative blood loss, length of hospital stay, postoperative drainage volume, postoperative parathyroid hormone, cosmetic effect, incidence of surgical complications and postoperative recurrence rate of the two groups were observed. Statistical software SPSS16.0 was used for statistical analysis of the data.Results:Both groups successfully completed the operation. Compared with the open group, the operation time ( t=11.232, P<0.001) and postoperative drainage volume ( t=2.892, P=0.003) of the robot group were more than those of the open group, and the aesthetic effect was better ( t=3.291, P=0.024). Intraoperative blood loss ( t=1.575 , P=0.118), hospital stay ( t=-1.784, P=0.091), postoperative PTH ( t=1.892, P=0.086), incidence of surgical complications ( χ2=3.291, P=0.610), visual analogue score of postoperative pain ( t=-2.431, P=0.081) and postoperative recurrence rate were not significantly different ( P>0.05). No recurrence occurred during follow-up. Conclusion:For patients with a selective benign thyroid tumor with a diameter of 5-8 cm, the bilateral axillo-breast and transaxillary approach for thyroid surgery by Da Vinci robot are safe, effective and have better cosmetic results.