Objective To investigate the possibility of interventional treatment of placenta accreta. Methods One patient with placenta accreta was treated with uterine arterial infusion of cef and MTX followed by embolization. Results Her placenta discharged through vagina at the 27th day after uterine aterial embolizayiea. No remnant was found in the uterine by Doppler imaging. The patient uneventfully recovered.Conclusions Intervetional therapy with uterine arterial embolization is a new and reliable method for treatment of placenta accheta.

AIM: To demonstrate the effects of telmisartan on the proliferation and apoptosis of U937 cells.METHODS: The proliferation ability of the U937 cells was assessed by CCK-8 assay and colony formation test with methylcellulose.The CD11b expression rate of the U937 cells was identified by flow cytometry.The apoptotic rate was analyzed by flow cytometry with Annexin V-PI double staining and Hoechst 33342 staining.The protein levels of cleaved PARP and cleaved caspase-3 were determined by Western blot.RESULTS: The results of CCK-8 assay confirmed that the viability of U937 cells was inhibited by telmisartan.The colony formation capacity of U937 cells was also significantly inhibited by telmisartan.The differentiation of U937 cells was induced by telmisartan with the expression of CD11b.The results of flow cytometry analysis with Annexin V-PI double staining and Hoechst 33342 staining identified that the apoptosis of U937 cells was induced by telmisartan in dose-dependent and time-dependent manners with the up-regulation of cleaved PARP and cleaved caspase-3 proteins.CONCLUSION: Telmisartan inhibits the proliferation and induces the differentiation of U937 cells.Telmisartan also induces the apoptosis of U937 cells through the caspase pathway.

Objective To observe the clinical efficacy of chaizhu liwei yin combined with domperidone in the treatment of functional dyspepsia(FD)with spleen deficiency and qi stagnation stype accompanied by sleep disorders.Methods A total of 80 elderly patients with FD with spleen deficiency and qi stagnation stype accompanied by sleep disorders in the Geriatric Clinic,Nangang Hospital of Hei-longjiang Academy of Chinese Medicine from September 2020 to September 2022 were selected as the research objects,and they were ran-domly divided into the observation group and the control group,with 40 cases in each group.The observation group was treated with domp-eridone tablets combined with chaizhu liwei yin,while the control group was treated with domperidone tablets,the patients in the two groups were given continuous administration for 4 weeks.The clinical efficacy,TCM syndrome efficacy evaluation score,Nepean dyspep-sia index(NDI)and Pittsburgh sleep quality index(PSQI)were observed before and after treatment in the two groups of elderly FD pa-tients.Results During the treatment,1 case was shed in the control group and 2 cases in the observation group.77 patients were includ-ed in the curative effect observation statistics,including 39 cases in the control group and 38 cases in the observation group.After treat-ment,the total effective rate of clinical symptoms in the observation group and the control group was 86.84％and 69.23％,respectively,and the observation group was better than the control group(P＜0.05).the scores of TCM syndrome efficacy evaluation in observation group and control group were lower than before treatment(P＜0.05),and the observation group was lower than the control group(P＜0.05);NDI scores of the observation group(77.13±5.62)and control group(61.03±5.33)were both improved compared with before treatment(P＜0.05),and the improvement of the observation group was higher than that of the control group(P＜0.05);the total scores of PSQI in the observation group(5.23±1.52)and control group(7.74±2.17)were lower than before treatment(P＜0.05),and the total scores of PSQI in the observation group was lower than that in the control group(P＜0.05);During the observation period,there were no obvious adverse reactions in the observation group and the control group,indicating the safety was high.Conclusion Chai liwei yin combined with domperidone can effectively relieve gastrointestinal symptoms in elderly FD patients with spleen deficiency and qi stagnation stype,improve sleep status and improve the quality of life in elderly patients.

Objective:To compare and analyze the short-term efficacy of the Da Vinci Xi (fourth generation) robotic surgical system and laparoscopic-assisted radical gastrectomy for gastric cancer.Method:In this retrospective cohort study, clinical pathological data of 190 patients with gastric cancer were collected from the clinical database of the First Affiliated Hospital of Dalian Medical University from 2020 Dec to 2023 May. The cohort comprised 136 men and 54 women aged 65 (30–85) years. Ninety of these patients had undergone robot assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the robot-assisted group. The remaining 100 patients had undergone laparoscopic- assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the laparoscopic control group. Variables investigated included surgical and postoperative factors and postoperative complications.Result:The procedure was successfully completed without the need to transition to open surgery in every patient in both groups. The median duration of surgery was 315 (270, 360) minutes and 240 (202, 280) minutes, median intraoperative blood loss 20 (10, 30) mL and 30 (10, 50) mL, median incision length 12.0 (10.8,13.0) cm and 10.0 (8.0, 10.8) cm, median time to first postoperative passage of flatus 4 (3, 5) days and 4 (4, 5) days, median time to first postoperative fluid intake 6 (4, 7) days and 8 (6, 9) days, time to gastric tube removal 4 (3, 7) days and 6 (5, 8) days, median time to drainage tube removal 8 (7, 10) days and 10 (9, 12) days, median duration of postoperative hospitalization 8 (7, 11) days and 12 (10, 14) days, and cost of surgery (7.6±1.2)×10 4 yuan and (4.0±0.6)×10 4 yuan in the robot-assisted and laparoscopic control groups, respectively. All the differences in the above indicators between the two groups of patients were statistically significant (all P<0.05). There were also significantly fewer complications in the robot-assisted than the laparoscopic control group (28.9% [26/90] vs. 44.0% [44/100], χ 2=0.31, P=0.031). Further subgroup analysis showed that the following factors were associated with greater improvement in the robot-assisted than laparoscopic control group: male sex (OR=0.41, 95%CI: 0.20–0.83, P=0.015), body mass index Conclusion:The Da Vinci robotic surgical system is safe and feasible for gastrectomy achieving a shorter recover period and fewer preoperative comorbidities.

Objective:To compare and analyze the short-term efficacy of the Da Vinci Xi (fourth generation) robotic surgical system and laparoscopic-assisted radical gastrectomy for gastric cancer.Method:In this retrospective cohort study, clinical pathological data of 190 patients with gastric cancer were collected from the clinical database of the First Affiliated Hospital of Dalian Medical University from 2020 Dec to 2023 May. The cohort comprised 136 men and 54 women aged 65 (30–85) years. Ninety of these patients had undergone robot assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the robot-assisted group. The remaining 100 patients had undergone laparoscopic- assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the laparoscopic control group. Variables investigated included surgical and postoperative factors and postoperative complications.Result:The procedure was successfully completed without the need to transition to open surgery in every patient in both groups. The median duration of surgery was 315 (270, 360) minutes and 240 (202, 280) minutes, median intraoperative blood loss 20 (10, 30) mL and 30 (10, 50) mL, median incision length 12.0 (10.8,13.0) cm and 10.0 (8.0, 10.8) cm, median time to first postoperative passage of flatus 4 (3, 5) days and 4 (4, 5) days, median time to first postoperative fluid intake 6 (4, 7) days and 8 (6, 9) days, time to gastric tube removal 4 (3, 7) days and 6 (5, 8) days, median time to drainage tube removal 8 (7, 10) days and 10 (9, 12) days, median duration of postoperative hospitalization 8 (7, 11) days and 12 (10, 14) days, and cost of surgery (7.6±1.2)×10 4 yuan and (4.0±0.6)×10 4 yuan in the robot-assisted and laparoscopic control groups, respectively. All the differences in the above indicators between the two groups of patients were statistically significant (all P<0.05). There were also significantly fewer complications in the robot-assisted than the laparoscopic control group (28.9% [26/90] vs. 44.0% [44/100], χ 2=0.31, P=0.031). Further subgroup analysis showed that the following factors were associated with greater improvement in the robot-assisted than laparoscopic control group: male sex (OR=0.41, 95%CI: 0.20–0.83, P=0.015), body mass index Conclusion:The Da Vinci robotic surgical system is safe and feasible for gastrectomy achieving a shorter recover period and fewer preoperative comorbidities.

Objective:To evaluate whether robotic gastrectomy using the da Vinci surgical system offers advantages over laparoscopic surgery in short-term outcomes and safety.Methods:Clinical data were collected from 247 patients who underwent either laparoscopic or da Vinci Xi surgical system-assisted radical gastrectomy for gastric cancer at Department of Gastrointestinal Surgery, First Affiliated Hospital of Dalian Medical University between Dec 2020 and Apr 2024. Intraoperative indicators and postoperative complications were compared between the two groups.Results:The operative time was 300 (270-360) minutes in the robotic surgery group and 240 (202-280) minutes in the laparoscopic group. Intraoperative blood loss was 20 (10-30) ml and 30 (10-50) ml, respectively. The incision length was 12.0 (10.0-12.0) cm for the robotic group and 10.0 (8.0-10.8) cm for the laparoscopic group. The first postoperative anal exhaust time was 4 (3-5) days in the robotic group and 4 (4-5) days in the laparoscopic group. The time to first intake of liquid diet was 5 (4-7) days in the robotic group and 8 (6-9) days in the laparoscopic group. The time to nasogastric tube removal was 4 (3-6) days and 5 (5-8) days, respectively. Drainage tube removal occurred at 8 (6-10) days in the robotic group and 10 (9-12) days in the laparoscopic group. The postoperative hospital stay was 9 (7-11) days for the robotic group and 12 (10-14) days for the laparoscopic group (all P<0.05). There were no statistically significant differences between the two groups in terms of proximal and distal resection margins, total number of dissected lymph nodes, or the dissection number of D 1 and D 2 lymph nodes ( P>0.05). The overall complication rate was significantly lower in the robotic group (28.6%) compared to the laparoscopic group (40.5%) ( χ2=39.59, P<0.001). The lower complication rate in the robotic group was mainly due to a reduction in surgery- and abdomen-related complications (14.3% vs. 33.9%, χ2=13.04, P<0.001). The robotic group had a higher proportion of mild complications according to the Clavien-Dindo classification, specifically grade Ⅰ ( χ2=5.07, P=0.024) and grade Ⅱ ( χ2=4.41, P=0.036). Conclusion:The da Vinci surgical system is a safe and feasible option for the treatment of gastric cancer, offering superior short-term outcomes compared to laparoscopic surgery.

Objective:To investigate the clinical efficacy of da Vinci Xi robotic surgical system assisted pylorus and vagus preserving partial gastrectomy (RaPPG) for early gastric cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 40 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Dalian Medical University from December 2020 to November 2022 were collected. There were 26 males and 14 females, aged (64±8)years. Of the 40 patients, 19 patients undergoing da Vinci Xi RaPPG were divided into the robotic assisted group, and 21 patients undergoing laparoscopic assisted pylorus and vagus preserving partial gastrectomy (PPG) were divided into the laparoscopic control group. Observation indicators: (1) surgical situations; (2) postoperative complications; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Surgical situations. All patients in the two groups underwent surgery successfully, without conversion to laparotomy. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to postoperative first liquid food intake, time to post-operative drainage tube removal, duration of postoperative hospital stay, tumor diameter, distance from distal resection margin to tumor were (298±52)minutes, 10(10, 10)mL, 3.0(3.0, 3.0)days, 3.0(3.0,4.0)days, 6.0(6.0,8.0)days, 7.0(6.0,8.0)days, (2.3±0.7)cm, 3.0(2.0,3.0)cm in patients of the robotic assisted group, versus (236±37)minutes, 25(15,50)mL, 5.0(4.0,5.0)days, 6.0(5.5,7.0)days, 8.0(8.0,9.5)days, 8.0(7.5,9.5)days, (2.9±1.1)cm ,2.0(1.5,2.0)cm in patients of the laparoscopic control group, showing significant differences in the above indicators between the two groups ( t=4.41, Z=-3.38, -4.75, -4.38, -2.98, -2.58, t=-2.10, Z=-3.03, P<0.05). (2) Postoperative complications. Cases with postoperative complications, cases with delayed gastric emptying, cases with acid regurgita-tion, cases with atelectasis, cases with infection of incision, cases with hyperamylasemia, cases with uroschesis were 6, 1, 1, 0, 1, 3, 0 in patients of the robotic assisted group. The above indicators were 20, 4, 3, 2, 1, 9, 1 in patients of the laparoscopic control group. There was a significant difference in the postoperative complications between the two groups ( χ2=17.77, P<0.05). (3) Follow-up. Of the 40 patients, 34 patients were followed up. There were 16 patients in the robotic assisted group who were followed up for 9(range, 6-18)months, and there were 18 patients in the laparoscopic control group who were followed up for 16(range, 9-23)months. During the follow-up period, all patients had good anastomosis healing, pyloric contraction function, and gastric emptying function. Conclusions:da Vinci Xi RaPPG is safe and feasible for the treatment of early gastric cancer. Compared with laparoscopic assisted PPG, treatment of gastric cancer with da Vinci Xi RaPPG can significantly reduce the volume of intraoperative blood loss, shorten the time to postoperative first flatus, time to postoperative first liquid food intake, time to postoperative drainage tube removal, duration of postoperative hospital stay, benefit the distance from distal resection margin to tumor, and reduce the incidence of postoperative complications.