Objective To evaluate the clinical diagnosis of gastric stromal tumors and the safety and feasibility with laparoscopic wedge resection.Methods The clinical data of diagnosis and treatment were retrospectively analyzed in 43 cases diagnosed as gastric stromal tumors by endoscopyic ultrasonography.Results Thirty-six cases were successful by laparoscopic surgery success rate being 83.7%.Endoscopic ultrasonography diagnosis rate was 69.0%.The positive rate of CD117 and CD34 in postoperative diagnosis of gastrointestinal stromal tumor wasl00%.The mean post-operative hospital stay was 5 days.Conclusion Endoscopyic ultrasonography can be selected as a main method for clinical diagnosis of gastric stromal tumors and laparoscopic resection was safe and feasible.

Objective: To observe the role of parenteral nutrition and laparoscopic therapy in chylous ascites.Methods: A patient with chylous ascites was therapied with parenteral nutrition(4 weeks) and laparoscopic therapy and parenteral nutrition(1 week) subsequently.Output of ascites was daily measured from the drainage catheter of abdominal cavity.The body weight and other nutritional indexes were determined.Results: During the course of parenteral nutrition,the production and output of ascites gradually decreased,the body weight increased,and the serum album in level kept unchanged.After laparoscopic therapy and parenteral nutrition(1 week),ascites decreased significantly and did not rebound after diet,the body weight and the serum album in level also obviously increased.Conclusion: Laparoscopic therapy and parenteral nutrition are very useful in the treatment of patients with chylous ascites.

Objective To explore the therapeutic strategy and clinical value of intraoperative chole-dochoscopy and electrohydraulic lithotripsy for refractory intrahepatic bile duct stones.Methods Liver pa-renchyma,intrahepatic bile duct and bile duct stones were explored under direct vision and intraoperative choledochoscope in 1 1 cases of refractory intrahepatic bile duct stones.Electrohydraulic lithotripsy and lithot-omy were performed to remove the stones and protect the liver parenchyma.If the stones could not be re-moved once,a secondary lithotripsy and lithotomy was performed through the fistula tract.Results All re-fractory calculi were crushed after one or two procedures and the clearance rate were 100%.No complica-tions occurred.Ten patients were followed up from 1 to 3 years except one.Three cases revealed recurrent stone during follow-up due to withdrawal of ursodeoxycholic acid capsules in 1 to 2 years.Seven others showed no stone recurrence within follow-up time.Conclusion Intraoperative choledochoscopy and electro-hydraulic lithotripsy is an easy technique and can effectively protect the liver parenchyma.The life quality of patients can be improved with low surgical risk and postoperative complications.

Objective: To analyze the epidemiological characteristics of infectious diseases at schools in Beijing from 2010 to 2020, providing evidence for the prevention and control strategies in school infectious diseases. Methods: Information on public health emergencies was collected from Public Health Emergency Reporting System (the subsystem of Chinese Disease Prevention and Control Information System) reported from 2010 to 2020. Results: A total of 146 public health emergencies and 138 public health emergencies of infectious diseases in schools were reported in Beijing from 2010 to 2020, including 4 291 cases with the rate of 2.32% and affected or exposed 185 179 cases. There were significant difference in mean annual incidence rates( χ 2=782.46, P <0.01). There were 71 events of respiratory infectious diseases and 66 events of intestinal infectious diseases, accounting for 51.45% and 47.83%, respectively. The annual incidence peaks of public health emergencies of infectious diseases were during March-June and October-December. The events mainly occurred in kindergartens and primary schools among each stage of school periods with 51 and 46 incidences respectively, which accounted for 70.29% of the total number of public health emergencies in schools. The leading infectious diseases among all the reported events in kindergartens and primary schools were hand foot mouth disease and varicella. Varicella and other infectious diarrhoeal diseases were at the top lists of infectious disease outbreaks at the secondary and university stages. Conclusion Infectious diseases events were the major type of public health emergencies at schools in Beijing from 2010 to 2020. Respiratory infectious diseases and intestinal infectious diseases were the keys to the prevention and control of public health emergencies related to school. It is necessary to strengthen the surveillance for public health emergencies especially for symptom surveillance. The prevention and control measures should be taken according to the characteristics of different age groups. At the same time, the prevention and control of school infectious diseases and the drill of the plan during peak periods need to be particularly strengthened.

Objective:To investigate the application value of Laennec approach in laparoscopic anatomical right hemihepatectomy (LARH).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 2 female patients who underwent LARH via Laennec approach in the First Affiliated Hospital of Kangda College of Nanjing Medical University from May to July 2020 were collected. The two patients were 51 and 57 years old, respectively. Observation indicators: (1) surgical situations; (2) postoperative situations and follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect post-operative survival and tumor recurrence of patients up to December 2020. Count data were repre-sented as absolute numbers.Results:(1) Surgical situations: 2 patients successfully underwent LARH via Laennec approach, without conversion to open surgery. The operation time was 180 minutes and 185 minutes, and the volume of intraoperative blood loss was 200 mL and 400 mL, respectively. No blood transfusion or gastrointestinal decompression was performed in either patient. (2) Postoperative situations and follow-up: 2 patients began to take liquid diet on the first day and out-of-bed activities on the postoperative second to third day. There was no postoperative bile fistula or bleeding, but different degrees of peritoneal and pleural effusion occurred to the 2 patients after operation. One case was improved after right-sided thoracentesis and chest tube drainage due to dyspnea, and the other case was cured after conservative therapy. There was no perioperative death. The duration of postoperative hospital stay of 2 patients was 13 days and 11 days, respectively. Results of pathological examination showed 1 case of hepatic hemangioma and 1 case of primary liver cancer, respectively. The Laennec capsule was observed on the hepatic vein branches of segment Ⅴ, Ⅵ, Ⅶ, Ⅷ, and the gap existed between the Laennec capsule and the hepatic vein. Two patients were followed up for 7 months and 5 months，respectively. They survived during the follow-up，without tumor recurrence.Conclusion:It is safe and feasible to perform LARH by Laennec approach.

Background and aims:Liver cirrhosis is a complex disease that may result in increased morbidity and mortality following bariatric surgery(BS).This study aimed to explore the outcome of BS in patients with unexpected cirrhosis,focusing on postoperative complications and the progression of liver disease. Methods:A retrospective study of bariatric patients with cirrhosis from four centers in China between 2016 and 2023 was conducted,with follow-up for one year after BS.The primary outcome was the safety of BS in patients with unexpected cirrhosis,while the secondary outcome was the metabolic efficacy of BS in this group postoperatively. Results:A total of 47 patients met the study criteria,including 46 cases of Child-Pugh class A cirrhosis and 1 case of Child-Pugh B.Pathological examination confirmed nodular cirrhosis in 21 patients(44.68％),pseudolobule formation in 1 patient(2.13％),lipedema degeneration with inflammatory cell infiltration in 3 patients(6.38％),and chronic hepatitis in 1 patient(2.13％).The average percentage of total weight loss was 29.73±6.53％at one year postoperatively.During the 30-day postoperative period,the complication rate was 6.38％,which included portal vein thrombosis,gastrointestinal bleeding,and intra-abdominal infection.Moreover,no cases of liver decompensation or mortality were reported during the follow-up period.The remission rates of comorbidities among 41 patients one year after surgery were as fol-lows:dyslipidemia 100％,type 2 diabetes 82.61％,hypertension 84.62％,and obstructive sleep apnea syndrome 85.71％. Conclusions:BS can be safely performed in patients with unexpected cirrhosis in the compensated stage of liver disease,with low postoperative morbidity and no mortality observed during one-year follow-up.

Adipose progenitor cells(APCs) represent a prominent stromal cellular component of adipose tissue and are now identified as highly heterogenous populations. However, the role of APCs in regulating systemic metabolism remains unknown. Using single cell RNA-sequencing, we investigated the role of the APC subpopulations in regulating development of type 2 diabetes. CD9 + CD55 low APCs are the novel subset identified in this study, which is significantly increased in type 2 diabetic patients. Transplantation of these cells from type 2 diabetic patients into adipose tissue caused glycemic disturbance in mice. Depletion of pathogenic APCs improved obesity-related glycemic disturbance. Collectively, our data provide deeper insights into human APC functionality and highlights APCs as a potential therapeutic target to combat type 2 diabetes. This study has been published in Nature Communications, 2024, 15(1): 4827.

Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrectomy in obese adolescents.Methods:The retrospective and descriptive study was conducted. The clinical data of 37 obese adolescents who were admitted to Drum Tower Hospital Affiliated to Nanjing University Medical School between July 2016 and August 2020 were collected. There were 18 males and 19 females, aged 18(range, 13?19)years. All patients underwent laparoscopic sleeve gastrec-tomy. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. The patients were followed up by outpatient review to detect body weight, blood glucose, blood lipid, blood pressure, nutrition situation and related complications at 3, 6 and 12 months after operation. The follow-up was up to August 2021. Measurement data with normal distribution were represented as Mean± SD. Repeated measurement data were analyzed by Repeated Measures Anova. Measurement data with skewed distribution were represented by M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical and postoperative situations. All 37 patients under-went laparoscopic sleeve gastrectomy successfully, the operative time was (50±7)minutes, the volume of intraoperative blood loss was (53±17)mL, and the duration of postoperative hospital stay was (3.0±0.5)days. Of the 37 patients, 2 cases had puncture infection. There was no complication such as bleeding occurred. (2) Follow-up. Of the 37 patients, 35, 31 and 22 cases were followed up at postoperative 3, 6 and 12 months, respectively. There was no anemia, malnutrition, trace element deficiency or other nutrition-related complications during the follow-up, and there was no death. The body mass, body mass index, homeostasis model assessment-insulin resistance, triglyceride, total cholesterol, systolic pressure, diastolic pressure, vitamin D, folate of the 37 patients were (117±19)kg, (40±5)kg/m 2, 6.59(range, 2.84?28.02), (1.6±0.7)mmol/L, (4.5±0.7)mmol/L, (141±22)mmHg (1 mmHg=0.133 kpa), (84±18)mmHg,(14±5)μg/L, (10±5)μg/L before the surgery, and (81±15)kg, (27±4)kg/m 2, 2.69(range, 1.08?9.71), (0.9±0.5)mmol/L, (4.5±0.7)mmol/L, (115±15)mmHg, (70±11)mmHg, (23±10)μg/L, (9±5)μg/L at postoperative 12 months. There were significant differences in the time effect of above indicators ( Ftime=214.14, 160.37, 12.66, 11.77, 2.90, 18.08, 11.32, 8.61, 5.04, P<0.05). The percentages of excess of body mass index lost of the 37 patients were 48%±19%, 77%±28% and 89%±24% at postoperative 3, 6 and 12 months, the percentages of excess weight loss were 42%±13%, 63%±17% and 75%±18%, the percentages of total body weight loss were 18%±5%, 26%±6% and 34%±7%, respectively. There were significant differences in the time effect of above indicators ( Ftime=83.96, 107.24, 109.06, P<0.05). The hemoglobin A1c was 4.8%, 5.0%, 5.1% and 4.9%, 5.2%, 5.2% in the 2 patients with type 2 diabetes at postoperative 3, 6 and 12 months, respectively, and they were relieved without drug treatment. Conclusion:Laparoscopic sleeve gastrectomy has definite short-term clinical efficacy in the treatment of adolescent obesity, which can effectively reduce excess body weight and improve the metabolic complications of insulin resis-tance, dyslipidemia and hypertension.

Objective:To analyze the temporal distribution characteristics of hand, foot and mouth disease (HFMD) in Beijing and provide reference evidence in HFMD prevention and control.Methods:The monthly incidence data of HFMD in Beijing from 2008 to 2023 were collected from Notifiable Disease Management Information System of the Chinese Information System of Disease Control and Prevention, and the epidemiological characteristics of HFMD were analyzed by the methods of time series seasonal decomposition graph, concentration degree, and circular distribution.The WPS office software 2019 was used to clean the data, Python software 3.12 was used to analyze and make statistical charts.Results:The monthly incidence fluctuation of HFMD in Beijing from 2008 to 2015 was higher than that from 2016 to 2022. From 2016 to 2022, the fluctuation range of monthly incidence showed a gradually decreasing trend.From 2008 to 2015, the concentration ( M) was 0.58, indicating a relatively strong seasonality; the mean angle ( α) calculated by the circular distribution method was 174.95°, and the mean angle standard deviation ( s) was 60.43°. The annual incidence peak occurred on June 27, and the incidence peak period was from April 27 to August 27. From 2016 to 2019 and 2023, the M was 0.57, indicating a relatively strong seasonality. The α was 228.05°, and s was 61.44°. The annual incidence peak occurred on August 20, and the incidence peak period was from June 18 to October 21. From 2020 to 2022, the M was 0.42, indicating a seasonality, the α was 238.27° and s was 76.35°. The annual incidence peak occurred on July 15, and the incidence peak period was from June 14 to November 14. The α of 2008-2015, 2016-2019 and 2023, and 2020-2022 were tested by the Watson-Williams method and the difference was statistically significant ( F=33 443.09, P<0.001). In 2023, the M was 0.77, indicating a strong seasonality. The incidence peak occurred on September 16, and the incidence peak period was from August 5 to October 28. Conclusions:The seasonality of HFMD in Beijing was obvious from 2008 to 2023, and the incidence peak day and peak period overall had rearward shifts. It is necessary to strengthen the comprehensive analysis of the distribution characteristics at different dimensions and the comprehensive prevention and control in key areas, places, and populations during the peak incidence period.

Introduction of a new magnetic anastomosis device for colostomy including its design and operaging principal. The anastomosis device is composed of magnetic base and anastomosis ring. It is convenient for colon and abdominal subcutaneous tissue going together through the magnetic attraction. The colostomy completes with magnetic compression anastomosis. The device has the advantage of making operation easer, reducing the operation steps and can better solve the colostomy ischemic necrosis, colostomy retraction, colostomy joint complications of skin mucous membrane and the skin diease around the colostomy. Patients can real y benefit from this device.