Objective:To evaluate the short-term outcomes of robotic double-flap technique following proximal gastrectomy in patients with carcinoma of esophagogastric junction(AEG).Methods:Clinical data of 5 AEG cases undergoing robotic double-flap technique following proximal gastrectomy were analyzed at the Department of Gastrointestinal Surgery, Peking University First Hospital from Dec 2023 to Aug 2024 .Results:All the 5 patients were of Siewert Ⅱ type AEG. Robot-assisted radical proximal gastrectomy and esophagogastric double-flap anastomosis were successfully completed. The operation time was (361±63) min, the installation time was (21±11) min, the anastomosis time was (90±21) min, and the median intraoperative blood loss was 100 (50,200) ml. The median number of intraoperative lymph nodes resected was 23 (14,32), the first postoperative exhaust time was (4.8±1.1) d, and postoperative hospital stay was (14.6±8.8) d. Postoperative abdominal distension occurred in 1 patient, and no significant anastomotic stenosis or anastomotic leakage was observed by upper gastroenterography. After conservative treatment, the patient recovered. None of them had Clavien-Dindo grade ≥Ⅲ complications. There were no anastomotic complications such as anastomotic leakage, anastomotic hemorrhage and anastomotic stenosis.Conclusion:Robotic double-flap technique following proximal gastrectomy is a safe and effective treatment for AEG.

Objective To investigate the relationship of serum programmed cell death 4(PDCD4)and a disintegrin and metalloprotease 10(ADAM10)levels with short-term prognosis in elderly patients with large artery atherosclerosis(LAA)-related acute cerebral infarction(AIS).Methods A total of 122 elderly patients with LAA-related AIS admitted in Nanyang Second People's Hos-pital during April 2022 and April 2024 were retrospectively enrolled and served as observation group.According to their neurological function,they were categorized into mild,moderate and se-vere subgroups(29,68 and 25 cases,respectively),and based on their prognosis,they were as-signed into good and poor prognosis subgroups(72 and 50 cases,respectively).Another 125 indi-viduals taking physical examination in above hospital during the same period were included as the control group.ELISA was applied to detect serum PDCD4 and ADAM10 levels.Multivariate logis-tic regression analysis was employed to investigate the relationship of above two indicators with short-term prognosis of LAA-related AIS patients.ROC curves were plotted to analyze the predic-tive value of the indicators for short-term prognosis of the patients.Results The serum PDCD4 and ADAM10 levels were significantly higher in the observation group than the control group(P＜0.01),in the moderate and severe subgroups than the mild subgroups(P＜0.05),and in the severe than the moderate subgroups(P＜0.05).Larger proportions of severe neurologic deficit and hypertension,and higher Hcy level were observed in the poor than the good prognosis sub-groups(P＜0.01).PDCD4 and ADAM10 were correlated with poor short-term prognosis in pa-tients with LAA-related AIS(OR=2.759,95％CI:1.479-5.146,P=0.001;OR=2.818,95％CI:1.559-5.093,P=0.001).The AUC value of PDCD4 and ADAM10 alone and their combination in predicting poor short-term prognosis was 0.840,0.864,and 0.935,respectively,and the combina-tion showed better predictive performance than alone(Z=2.687,2.008,P＜0.05).Conclusion Serum PDCD4 and ADAM10 levels are higher in patients with LAA-related AIS.Their combina-tion showed good predictive efficacy for poor short-term prognosis of these patients.

Objective To construct and validate a nomogram-based prediction model of vascular plaque stability in patients with progressive cerebral infarction based on serum monocyte chemotactic protein-1(MCP-1),monocyte chemotactic protein-1 inducible protein 1(MCPIP1)combined with inflammatory factors.Methods A retrospective cohort study was conducted on 200 patients with progressive cerebral infarction admitted to our department from January to December 2023.All of them were assigned into a modeling group,and were divided into a stable plaque subgroup and the unstable plaque subgroup according to results of carotid multilayer spiral CT angiography.Their general data,results of laboratory tests,and other clinical indicators were collected to identify the influencing factors for vascular plaque instability with single-factor and multifactor analyses.Then a nomogram model for predicting vascular plaque stability was constructed for patients with progressive cerebral infarction.Receiver operating characteristics(ROC)curve was plotted to evaluate the predictive performance of the nomogram model.Subsequently,in a ratio of 7∶3 between the cases in the modeling group and the validation group,another 86 patients with progressive cerebral infarction admitted to our department from January to June 2024 were enrolled and served as the validation group.Their clinical data were collected for external validation of the model.Results In the modeling group,there were 68 patients(34.00％)in the stable plaque subgroup and 132 patients(66.00％)in the unstable plaque subgroup.Univariate analysis showed that there were significant differences between the 2 subgroups in terms of age(65.31±6.74 vs 67.52±7.14 years,t=2.113),comorbid diabetes mellitus[35(48.53％)vs 80(60.61％)cases,Chi-square=7.182],MCP-1(570.67±104.23 vs 693.94±128.45 pg/mL,t=6.836),MCPIP1(2.93±0.58 vs 4.08±0.75 ng/mL,t=11.051),homocysteine(Hcy,10.56±2.38 vs 16.04±3.54 μmol/L,t=11.491),C-reactive protein(CRP,6.16±2.03 vs 8.05±2.67 mg/L,t=5.122)and TNF-α(1.31±0.29 vs 1.79±0.47 ng/mL,t=7.696)(all P＜0.05).Multivariate analysis indicated that age(β=0.103,OR=1.109,95％CI=1.012～1.215),comorbid diabetes(β=2.135,OR=8.461,95％CI=1.866～38.353),Hcy(β=0.706,OR=2.026,95％CI=1.550～2.650),MCP-1(β=0.011,OR=1.011,95％CI=1.004～1.018),MCPIP1(β=1.928,OR=6.875,95％CI=2.765～17.094),CRP(β=0.327,OR=1.387,95％CI=1.022～1.883)and TNF-α(β=1.491,OR=4.443,95％CI=1.389～14.212)were independent influencing factors for vascular plaque instability in the patients with progressive cerebral infarction(all P＜0.05).The modeling formula based on these factors was Logit(P)=0.103×(age)+2.135×(combined diabetes)+0.706×(Hcy)+0.01 1×(MCP-1)+1.928×(MCPIP1)+0.327×(CRP)+1.491×(TNF-α)-34.684.ROC curve analysis revealed that the area under curve(AUC)of the model in the modeling group was 0.956(95％CI:0.931～0.981,P＜0.001),with a sensitivity of 0.841 and a specificity of 0.926,and the AUC value in validation group was 0.960(95％CI=0.925～0.996,P＜0.001).Conclusion Our nomogram prediction model has a good predictive performance for vascular plaque instability in patients with progressive stroke,and it can be used to identify high-risk patients for vascular plaque instability in clinical practice.

Objective To investigate the relationship of serum programmed cell death 4(PDCD4)and a disintegrin and metalloprotease 10(ADAM10)levels with short-term prognosis in elderly patients with large artery atherosclerosis(LAA)-related acute cerebral infarction(AIS).Methods A total of 122 elderly patients with LAA-related AIS admitted in Nanyang Second People's Hos-pital during April 2022 and April 2024 were retrospectively enrolled and served as observation group.According to their neurological function,they were categorized into mild,moderate and se-vere subgroups(29,68 and 25 cases,respectively),and based on their prognosis,they were as-signed into good and poor prognosis subgroups(72 and 50 cases,respectively).Another 125 indi-viduals taking physical examination in above hospital during the same period were included as the control group.ELISA was applied to detect serum PDCD4 and ADAM10 levels.Multivariate logis-tic regression analysis was employed to investigate the relationship of above two indicators with short-term prognosis of LAA-related AIS patients.ROC curves were plotted to analyze the predic-tive value of the indicators for short-term prognosis of the patients.Results The serum PDCD4 and ADAM10 levels were significantly higher in the observation group than the control group(P＜0.01),in the moderate and severe subgroups than the mild subgroups(P＜0.05),and in the severe than the moderate subgroups(P＜0.05).Larger proportions of severe neurologic deficit and hypertension,and higher Hcy level were observed in the poor than the good prognosis sub-groups(P＜0.01).PDCD4 and ADAM10 were correlated with poor short-term prognosis in pa-tients with LAA-related AIS(OR=2.759,95％CI:1.479-5.146,P=0.001;OR=2.818,95％CI:1.559-5.093,P=0.001).The AUC value of PDCD4 and ADAM10 alone and their combination in predicting poor short-term prognosis was 0.840,0.864,and 0.935,respectively,and the combina-tion showed better predictive performance than alone(Z=2.687,2.008,P＜0.05).Conclusion Serum PDCD4 and ADAM10 levels are higher in patients with LAA-related AIS.Their combina-tion showed good predictive efficacy for poor short-term prognosis of these patients.

Objective:To evaluate the short-term outcomes of robotic double-flap technique following proximal gastrectomy in patients with carcinoma of esophagogastric junction(AEG).Methods:Clinical data of 5 AEG cases undergoing robotic double-flap technique following proximal gastrectomy were analyzed at the Department of Gastrointestinal Surgery, Peking University First Hospital from Dec 2023 to Aug 2024 .Results:All the 5 patients were of Siewert Ⅱ type AEG. Robot-assisted radical proximal gastrectomy and esophagogastric double-flap anastomosis were successfully completed. The operation time was (361±63) min, the installation time was (21±11) min, the anastomosis time was (90±21) min, and the median intraoperative blood loss was 100 (50,200) ml. The median number of intraoperative lymph nodes resected was 23 (14,32), the first postoperative exhaust time was (4.8±1.1) d, and postoperative hospital stay was (14.6±8.8) d. Postoperative abdominal distension occurred in 1 patient, and no significant anastomotic stenosis or anastomotic leakage was observed by upper gastroenterography. After conservative treatment, the patient recovered. None of them had Clavien-Dindo grade ≥Ⅲ complications. There were no anastomotic complications such as anastomotic leakage, anastomotic hemorrhage and anastomotic stenosis.Conclusion:Robotic double-flap technique following proximal gastrectomy is a safe and effective treatment for AEG.

Objective To conduct basic research on the structure and function of the heart in cynomolgus monkeys older than 10 years to provide data for animal selection in elderly disease research.Methods A total of 144 cynomolgus monkeys＞10 years old were selected as research subjects,including 37 females and 66 males in the 10～15 years group,and 21 females and 20 males in the 16～20 years group.Basic data on cardiac structure and function in middle-aged and elderly cynomolgus monkeys were obtained through comparative analysis of general indicators(body mass index,blood pressure,and heart rate),blood biochemical indicators(blood glucose,blood lipids,and ion indicators),and cardiac structure and function indicators.Results General indicators for the 10～15 years and 16～20 years groups were compared.As age increased,the blood pressure and heart rate of female and male monkeys increased,and there was a significant difference in blood pressure changes between male monkeys.A comparison of two sets of blood biochemical indicators showed that,as age increased,blood glucose,triglycerides,total cholesterol,low-density lipoprotein cholesterol,blood calcium,blood sodium,and blood potassium increased,while lactate dehydrogenase decreased,in female and male monkeys.Among these,blood glucose,triglycerides(males),total cholesterol,high-density lipoprotein cholesterol(males),low-density lipoprotein cholesterol(males),blood calcium,blood sodium,blood potassium,and lactate dehydrogenase showed significant changes.A comparison of cardiac contractile function between the two groups showed that,as age increased,the anterior and posterior diameters of the left atrium significantly decreased in both female and male monkeys.Female monkeys showed a significant decrease in the interventricular septal end systolic diameter,left ventricular end diastole and systolic diameters,left ventricular end diastolic and systolic volumes,and left ventricular mass index,while no significant changes were seen in male monkeys.A comparison of diastolic function between the two groups showed that,as age increased,the late diastolic velocity of the mitral valve decreased significantly in male monkeys,while the early diastolic velocity of the left ventricular sidewall increased significantly in female monkeys.Correlation analysis was conducted between the metabolic indicators and the cardiac structure and function indicators of female and male monkeys.The correlations between metabolic indicators and cardiac structure and function indicators were weak in female monkeys,for which the maximum absolute Γ value did not exceed 0.39.However,the correlations between metabolic indicators and cardiac structure and function indicators were relatively strong in male monkeys,for which the maximum absolute Γ value reached 0.66.Conclusions Based on ultrasound analysis combined with metabolic indicators,the heart function of cynomolgus monkeys was studied,and basic data related to the structure and function of the heart in middle-aged and elderly cynomolgus monkeys were obtained.As age increased,blood glucose and lipid indicators increased in cynomolgus monkeys,while cardiac systolic and diastolic functions show a downward trend,similar to changes in middle-aged and older adult human populations.These data provide support for animal selection in research on age-related diseases related to heart function.

Objective:To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients aged 10 to 21 years.Methods:We conducted a retrospective analysis of clinical data from 89 out of 200 patients who underwent LSG at the Gastrointestinal Surgery/Weight Loss Center of the First Affiliated Hospital of Jinan University between January 2015 and December 2020. The primary outcome measures were the completion rate of LSG, the incidence of perioperative complications, and weight-related indicators 3, 6, 12, and ≥24 months postoperatively. Additionally, we compared glucose metabolism, lipid metabolism, vitamin levels, liver function, and other relevant biochemical variables before and after surgery. Normally distributed continuous data are presented as x±s. Because the numbers of patients at each follow-up time point were not identical with the number of patients in the study cohort preoperatively, independent sample t-tests were used for intergroup comparisons. Non-normally distributed continuous data are presented as M( Q1, Q3), and Mann-Whitney U tests were used for intergroup comparisons. Results:Among the 89 patients, 35 were male (39.3%), the mean age was (18±2) years, and mean body mass index (BMI) 38.5±4.8 kg/m2; 37 of the patients having a BMI greater than 40 kg/m2. Additionally, 63 patients (70.8%) had fatty livers, 34 (38.2%) hyperuricemia, 31(34.8%) sleep apnea syndrome, 20 (22.4%) gastroesophageal reflux, eight (8.9%) type 2 diabetes, and two (2.2%) hypertension. All 89 patients underwent LSG surgery successfully, with no conversions to open surgery. During the perioperative period, there were no cases of major bleeding, gastric leakage, or infections. Notable postoperative symptoms included nausea, vomiting, and pain, most of which improved by the second postoperative day. BMI values 3, 6, and 12 months postoperatively had decreased to 31.5±5.8 kg/m2, 28.6±4.3 kg/m2, and 26.3±4.4 kg/m2, respectively. All of these BMI values differed significantly from preoperative values (all P<0.05). At 12 and ≥24 months postoperatively, the percentages of total weight loss were (31.3±9.3)% and (33.1±10.5)%, respectively, both differing significantly from 3 months postoperatively (20.5±5.1)% (all P<0.05). The percentages of excess weight loss at 12 and ≥24 months postoperatively were 91% (70%, 113%) and 95% (74%, 118%) , respectively, both differing significantly from the percentage of total weight loss 3 months postoperatively (56% [45%, 72%]) (both P<0.05). Alanine transaminase and aspartate transaminase serum concentrations decreased from preoperative values of 44.4 (25.5, 100.5) U/L and 29.0 (9.5, 48.0) U/L to 14.0 (10.8, 18.3) U/L and 13.0 (10.5, 17.3) U/L, respectively, ≥24 months postoperatively. Hemoglobin A1c decreased from 5.6 (5.3, 5.8)% preoperatively to ≥24 months postoperatively 5.3 (5.0, 5.4)%. High-density lipoprotein increased from 1.0 (0.9, 1.2) mmol/L preoperatively to 1.4 (1.1, 1.6) mmol/L ≥24 months postoperatively. Vitamin B12 decreased from 350.0 (256.8, 441.3) μg/L preoperative to 230.3(195.4, 263.9) μg/L ≥24 months postoperatively. All differed significantly from preoperative values (all P<0.05). Conclusion:LSG has favorable efficacy in morbidly obese patients aged 10 to 21 years. However, further confirmation is required through long-term, multicenter, randomized, controlled trials.

Objective:To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients aged 10 to 21 years.Methods:We conducted a retrospective analysis of clinical data from 89 out of 200 patients who underwent LSG at the Gastrointestinal Surgery/Weight Loss Center of the First Affiliated Hospital of Jinan University between January 2015 and December 2020. The primary outcome measures were the completion rate of LSG, the incidence of perioperative complications, and weight-related indicators 3, 6, 12, and ≥24 months postoperatively. Additionally, we compared glucose metabolism, lipid metabolism, vitamin levels, liver function, and other relevant biochemical variables before and after surgery. Normally distributed continuous data are presented as x±s. Because the numbers of patients at each follow-up time point were not identical with the number of patients in the study cohort preoperatively, independent sample t-tests were used for intergroup comparisons. Non-normally distributed continuous data are presented as M( Q1, Q3), and Mann-Whitney U tests were used for intergroup comparisons. Results:Among the 89 patients, 35 were male (39.3%), the mean age was (18±2) years, and mean body mass index (BMI) 38.5±4.8 kg/m2; 37 of the patients having a BMI greater than 40 kg/m2. Additionally, 63 patients (70.8%) had fatty livers, 34 (38.2%) hyperuricemia, 31(34.8%) sleep apnea syndrome, 20 (22.4%) gastroesophageal reflux, eight (8.9%) type 2 diabetes, and two (2.2%) hypertension. All 89 patients underwent LSG surgery successfully, with no conversions to open surgery. During the perioperative period, there were no cases of major bleeding, gastric leakage, or infections. Notable postoperative symptoms included nausea, vomiting, and pain, most of which improved by the second postoperative day. BMI values 3, 6, and 12 months postoperatively had decreased to 31.5±5.8 kg/m2, 28.6±4.3 kg/m2, and 26.3±4.4 kg/m2, respectively. All of these BMI values differed significantly from preoperative values (all P<0.05). At 12 and ≥24 months postoperatively, the percentages of total weight loss were (31.3±9.3)% and (33.1±10.5)%, respectively, both differing significantly from 3 months postoperatively (20.5±5.1)% (all P<0.05). The percentages of excess weight loss at 12 and ≥24 months postoperatively were 91% (70%, 113%) and 95% (74%, 118%) , respectively, both differing significantly from the percentage of total weight loss 3 months postoperatively (56% [45%, 72%]) (both P<0.05). Alanine transaminase and aspartate transaminase serum concentrations decreased from preoperative values of 44.4 (25.5, 100.5) U/L and 29.0 (9.5, 48.0) U/L to 14.0 (10.8, 18.3) U/L and 13.0 (10.5, 17.3) U/L, respectively, ≥24 months postoperatively. Hemoglobin A1c decreased from 5.6 (5.3, 5.8)% preoperatively to ≥24 months postoperatively 5.3 (5.0, 5.4)%. High-density lipoprotein increased from 1.0 (0.9, 1.2) mmol/L preoperatively to 1.4 (1.1, 1.6) mmol/L ≥24 months postoperatively. Vitamin B12 decreased from 350.0 (256.8, 441.3) μg/L preoperative to 230.3(195.4, 263.9) μg/L ≥24 months postoperatively. All differed significantly from preoperative values (all P<0.05). Conclusion:LSG has favorable efficacy in morbidly obese patients aged 10 to 21 years. However, further confirmation is required through long-term, multicenter, randomized, controlled trials.

Objective:To study the clinical characteristics and compliance of early-onset gout patients by case-control analysis.Methods:A total of 111 early-onset patients (onset age ≤35 years old) were included as Group A, and 111 non-early-onset patients (onset age >35 years old) with matched disease durationwere included as Group B. The differences ofclinical characteristics, causes of acute gout attack, dairy diet habits, compliance, and misunderstanding of the disease were compared.Results:Compared with the non-early-onsetgoutpatients, the early-onset patients had a higher proportion of obesity (63 cases vs 28 cases), family history (36 cases vs 20 cases) and tophus (39 cases vs 23 cases) and higher level of VAS scores (8.5±1.3 vs 7.6±1.7; χ2=22.988, P<0.01; χ2=5.749, P=0.016; χ2=5.729, P=0.017; t=4.639, P<0.01), lowerproportionof the first metatarsophalangeal joint involvement as the initial joint involvement (45.9%, 51 cases vs 59.4%, 66 cases; χ2=4.066, P=0.044), higher proportion of the ankle involvement as the initial joint involvement (34.2%, 38 cases vs 21.6%, 24 cases; χ2=4.386, P=0.036), higher proportion of alcohol drinkers and high fructose drinkers, which was more likely to relate to alcohol intake, strenuous exercise and high fructose intakeas trigger of the flare ( χ2=6.513, P=0.011; χ2=7.126, P=0.008; χ2=1.978, P=0.160), while the proportion of regular exercisers and on diet in the family was lower ( χ2=22.887, P<0.01; t=-4.917, P<0.01). The proportion of poor diet and medication compliance in Group A was higher than that in Group B(57.7%, 64 cases vs 38.7%, 43 cases; χ2=5.207, P=0.022; χ2=5.867, P=0.015). As for the reason for poor treatment compliance, early-onset gout patients were more worry about the side-effects of drugs than non-early onset patients ( χ2=4.190, P=0.041). There was no significant difference between the two groups in the main misunderstanding of gout. Conclusion:Although early onset gout patients are young, their condition is more serious, and compliance is poorer, this group of patients should be highly valued in clinical diagnosis and treatment.

Purpose To investigate the value of simultaneousnon-contrast angiographyand intra-plaquehemorrhage (SNAP) in assessing Willis circle integrity of the brain using three-dimensional time of flight (TOF) MRA as a reference. Materials and Methods According to the inclusion criteria, a total of 62 patients with stroke symptoms within 3 months were collected. All patients underwent head SNAP and TOF on Philips 3.0T MR scanner. TOF and SNAP were treated respectively at the Philips workstation using maximum and minimum intensity projections to generate non-enhanced MRA images which were, afterwards, interpreted using blind reading to determine the presence or absence of individual blood vessels in the circle of Willis. In order to assess the consistency of the interpretation, all images were interpreted again 2 weeks later to avoid memory bias. Finally, The consistency of the two interpretations was analyzed, and the ability of SNAP and TOF in evaluating the integrity of Willis circle was compared. In addition, for 15 patients with VISTA images, the plaque of Willis circle vascular wall was evaluated using SNAP and VISTA images to compare their evaluation ability. Results The results of the first and second interpretations of SNAP and TOF were highly consistent. The arteries with exactly the same interpretation included left anterior cerebral artery A1 (LA1), right anterior cerebral artery A1 (RA1), left posterior cerebral artery P1 (LP1) and right posterior cerebral artery P1 (RP1) (Kappa=1.000). The results in terms of left posterior communicating artery (LPCoA) (Kappa=0.926 and 0.924, respectively), right posterior communicating artery (RPCoA) (Kappa=0.931 and 0.732, respectively) and integrity (Kappa=0.815 and 0.816, respectively) were relatively consistent, while there was a relatively low consistency in terms of anterior communicating artery (ACoA) (Kappa=0.640 and 0.675, respectively). In evaluating the constituent vessels of the circle of Willis and its integrity, SNAP and TOF showed good consistency. Vessels with identical SNAP and TOF interpretations include LA1, RA1, LP1, and RP1 (Kappa=1.000). The interpretation consistency of the two imaging techniques on LPCoA (Kappa=0.852 and 0.848), RPCoA (Kappa=0.796 and 0.796, respectively), and integrity (Kappa=0.701 and 0.742, respectively) was relatively high. While the consistency of SNAP and TOF in terms of ACoA was slightly lower (Kappa=0.680 and 0.714, respectively). In assessing the plaque of Willis circle vascular wall, the evaluation results of SNAP and VISTA were consistent. Conclusion As a non-enhanced angiography technique, the magnetic resonance SNAP sequence can well evaluate the integrity of Willis circle, as well as the presence or absence of plaque on Willis circle vascular wall.