BACKGROUND: Biliary ischemia-reperfusion injury is one of the main reasons for the injury bile duct following liver transplantation, liver resection and hepatic artery thrombosis after chemotherapy. However, nothing has been decided yet concerning liver can tolerate long intrahepatic bile ducts ischemia under normal temperature. OBJECTIVE: To use the rabbit biliary ischemia-reperfusion injury, model, analyze the rabbit intrahepatic bile ducts ischemia security time. METHODS: Rabbits were randomly divided into sham operation, hepatic artery and common bile duct joint blocking 1.5, 2, 2.5, 3 h groups. Sham operation group only free common bile duct, hepatic artery and portal vein. Hepatic artery and common bile duct joint blocking 1.5, 2, 2.5, 3 h groups, left and right hepatic duct openings superior margin was clamped using artery clamps, and hepatic artery, common bile duct and loose connective tissue were occluded. Following 1.5, 2, 2.5 and 3 hours, artery clamps were removed to recover hepatic artery or biliary tract blood flow. After a week, animal survival was calculated and liver function was tested. RESULTS AND CONCLUSION: None animals in the sham operation and hepatic artery and common bile duct joint blocking 1.5 hour groups died;survival rate was 87.5% following 2 hours of blocking. Animal survival rate was decreased gradually with prolonged blocking time of blood flow. These indicated that the maximum safety time of blocking biliary duct blood flow was 2 hours. Pathological and histological changes were mild within 2 hours of blocking, mainly presenting cell edema and inflammatory cell infiltration, and necrotic focus was punctiform or fragmentis, reversible. While ischemia above 2 hours, bile duct epithelial necrotic shape was significant. The obvious, hepatic necrosis was multifocal, flake, irreversible damage. Histological change also confirmed that 2 hours may be maximum security limitation of rabbit tolerance intrahepatic bile duct flow blocking under normal temperature.

Twenty-four patients with parapharyngeal space tumors were treated from 1964 to 1999.There were 11 males and 13 females,ranging in age from 10 to 71 years old.Among 24 patients, benign tumors were 17(70.8%),malignant tumors 7(29.2%).The diagnosis of these tumors were biopsy and CT scaning .Pathologic results showed that the original tumors were salivary gland tissue in 11(45.8%),cranial nerve in 7(29.2%),vascular tissue in 2(8.3%)and the unidentified in 4(16.7%).The surgical approaches for these tumors were neck side incision in 19,through mouth in 5.Results showed that 4 malignant tumors were died in one year,3 cases did not clear;the prognosis of 17 benign tumors were well.

ObjectiveTo discuss the effect of surgical treatment of varicose vein on primary chronic venous insufficiency(PCVI) in the lower extremities.MethodsBetween August 2007 and August 2008,128PCVIpatients underwenthighligationof the greatsaphenousveinandendovenous electrocoagulation of the varix superficial vein. Spectrum Doppler ultrasound was used to measure the superficial femoral vein blood flow hemodynamic information beneath the first pair of valve including quiet breathing condition and the Valsalva action (reflux time、caliber、reflux velocity). Reflux index (RI) was used as guide line.ResultsClinical sympotoms improved in 54 out of 60 mild PCVI cases, in 29 of 45 moderate PCVI patients, while only in 6 out 23 cases in whom severe preoperative clinical symptom with PCVI was present.The effective rate respectively was 90％, 64％, and 30％.The mild reflux index significantly improved than that before operation ( t = 21. 484, P = 0. 000 ), the moderate reflux index improved than that before operation ( t = 2. 173, P = 0. 035 ), while the serious reflux index were not statistically improved than that before operation( t = 1. 888, P = 0. 078 ). In all cases reflux index improved after the surgery ( x2 = 8. 266,P = 0. 004).ConclusionsMinimally invasive surgical treatment of varicose veins can improve the reflux of the deep vein in PCVI cases with mild to moderate clinical symptom.

Objective To investigate the effect of clinical classification and operational methods of gallblad-der carcinoma on the prognosis.Methods Clinical data of 88 patients with gallbladder carcinoma treated surgically from January 1994 to December 2004 were retrospectively analyzed.Results 8 cases were in class Ⅰ and Ⅱ , 14 in class Ⅲ ,28 in class Ⅳ,38 in class Ⅴ.The mean survival of these 4 classifications was 36.5,9.3,4.6,3.9 months respectively.There was a remarkable difference(P <0.01,P<0.05) in survival among these 4 classifications ex-cept between class Ⅳ and class Ⅴ (P0.05).The mean survival of radical resection and palliative resection in class Ⅳ and Ⅴ was 4.2 and 3.8 months.There was no remarkable difference( P0.05 ) between them.Conclusion The key to increase the therapeutic effect gallbladder carcinoma is early diagnosis and radical resection.

Objective:To investigate the sensitivity and the specificity of scorpions amplification refractory mutation system ( ARMS) in comparing with that of direct DNA sequencing in the detection of BRAF gene mutations in patients with papillary thyroid microcarcinoma.Methods:Direct sequencing and ARMS were used simultaneously to detect BRAF mutation status in 56 patients with PTMC.Results:BRAF mutations were identified in 46 cases with a mutation rate of 82.9%by ARMS,while in 18 cases with a mutation rate of 32.1%by direct sequencing.Besides,the sensitivity of ARMS was 100%and that of direct sequencing was 39.1%.There were significant differences of both mutation rate and sensitivity between two methods ( P<0.01 ).Conclusion: Compared to direct sequencing,ARMS gains a higher sensitivity in the detection of BRAF mutations in samples with tiny lesions.

Objective:To explore the real experience of nutritional support in patients with chronic heart failure and acute decompensation during hospitalization, understand the common needs, so as to provide a reference for implementing targeted support and constructing nutritional support programs for this group in the future.Methods:From January to February 2022, 15 patients with chronic heart failure and acute decompensation in Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences were interviewed in depth in a one-to-one, semi structured way using the purposeful sampling method. Colaizzi phenomnological 7-step analysis method was applied to analyze, summarize and refine the theme.Results:Through detailed analysis of data, five themes were extracted, namely, diversification of emotional experience, polarization of nutrition emphasis, dissatisfaction with hospital nutrition support, health related behavior change, and internal drive.Conclusions:Acute decompensated patients with chronic heart failure experience a variety of emotional experiences on nutritional support during hospitalization, and are dissatisfied with hospital nutritional support. Their attention to nutrition is polarized. The change of health behavior is manifested in the awareness of nutrition, positive change and willingness to participate in nutrition decision-making. Therefore, medical staff should speed up and improve the promotion of nutritional support programs for patients with chronic heart failure to promote their rehabilitation and improve their quality of life.

Objective To optimize plan for right lobe living donor hepatectomy based on the territorial volume drained by the middle hepatic vein (MHV) as shown by preoperative MR image in donors.Methods Utilizing preoperative MR dynamic enhancement scanning image,virtually plot three types of hepatic parenchyma transsection plane based on the variation of including MHV for right lobe graft procurement. Results From June 2006 to May 2010,65 adult-to-adult right lobe living donor liver transplantations was performed at General Hospital of Chinese PLA,in which there were 43 grafts including MHV (66.2％,43/65 ), eight grafts including partial MHV which was dissected before the V4b abouchement ( 12.3％,8/65) and 14 grafts not including MHV (21.5％,14/65). There was no postoperative death in donors and the postoperative complications developed in 10.76％ (7/65). The recipients' perioperative mortality was 7.69％ (5/65). Ttwenty-one complications developed in 18 recipients,and the morbidity was 32.31％. The cumulative survival rates were 86％,77％ and 68％respectively for 1,2 and 3 years. Conclusions The optimizing liver resection plane could be practically designed preoperatively for right lobe graft procurement based on the territorial volume drained by MHV.

Objective:Through meta-analysis, the association of three common adipokines (leptin, adiponectin, and chemerin) with bone nutrition of senile osteoporosis (SOP) in China was systematically evaluated.Methods:CNKI, CBM, VIP, Wanfang, PubMed, Web of Science, Embase, Cochrane Library, and other databases were searched for articles published from the establishment of the database to July 30, 2022. After literature screening, data extraction, and quality evaluation of the included studies were independently conducted by two researchers, a meta-analysis was performed using RevMan5.4 and Stata17.0 softwares.Results:A total of 13 studies in the Chinese population were included, including 897 patients with SOP and 673 elderly with normal bone mineral density . The results of the meta-analysis showed that compared with the control group, the serum leptin levels were significantly lower ( MD -2.64, 95% CI -4.04 to -1.23, P < 0.001), chemerin levels were significantly higher ( MD 25.23, 95% CI 14.57 to 35.90, P < 0.001), and adiponectin levels were not significantly different ( MD -0.55, 95% CI -2.26 to 1.17, P > 0.05) in SOP patients. After subgroup analysis according to the measurement method, leptin levels remained lower in SOP patients than in the control group. Conclusions:Compared with the control group, leptin levels were lower and chemerin levels were higher in SOP patients. Therefore, dysregulation of adipokines may play an important role in the occurrence and development of SOP, and regulation of adipokine levels and functions may play a role in the treatment of SOP and the improvement of bone nutrition as a nutritional intervention.

Objective T he effects of different intensity aerobic exercise on the coagulation function of stroke were investigated by detection coagulation index of stroke patients before and after different intensity of aerobic training.Methods 120 patients with neurological initial stroke were enrolled from January to Decem-ber in 2016.According to the cardiopulmonary exercise test,the patients were divided into medium-intensity aerobic exercise group,low-intensity aerobic exercise group and control group.The control group maintained the basic medical treatment of neurological primary stroke.The medium-intensity aerobic exercise group and low-intensity aerobic exercise group were on the basis of the control group with different intensity by stampe-ding power bike training.The plasma fibrinogen(FIB),D-Dimer(D-D),activated partial thromboplastin time (APTT),prothrombin time(PT),international normalized ratio(INR)and thrombin time(TT)were detected and analyzed before and after exercise training.Results The results showed there were no significant differ-ence in coagulation index between the three groups before exercise training(P>0.05).The levels of FIB and D-D in medium-intensity aerobic exercise group after the training were significantly lower than before the training(P<0.05).The levels of FIB in low-intensity aerobic exercise group after the training were signifi-cantly lower than before the training(P<0.05).There were no significant difference between in others coagu-lation index between two groups(P>0.05).There were no significant difference in coagulation index between before and after the basic treatment in control group(P>0.05).After exercise training,the levels of FIB in the moderate intensity group was significantly lower than the low intensity group(P<0.05),and then the low intensity group was significantly lower than control group(P<0.05).Conclusion The medium and low-intensity aerobic exercise could influence the coagulation function of stroke patients,particularly in the medi-um-intensity.It provided the scientific basis for individual aerobic exercise combined with drugs to prevent stroke recurrence.

Objective To compare the short-term clinical efficacies of Da Vinci robotic surgical systemassisted and laparoscopy-assisted radical gastrectomy for locally advanced gastric cancer (GC).Methods The retrospective cohort study was conducted.The clinicopathological data of 162 patients who underwent minimally invasive radical gastrectomy for locally advanced GC in the First Affiliated Hospital of Army Medical University between September 2016 and September 2017 were collected.Of 162 patients,65 undergoing Da Vinci robotic surgical system-assisted radical gastrectomy were allocated into the robotic group and 97 undergoing laparoscopyassisted radical gastrectomy were allocated into the laparoscopic group.According to Japanese gastric cancer treatment guidelines,patients with upper GC and with middle or lower GC underwent respectively total gastrectomy + D2 lymph node dissection and distal subtotal gastrectomy + D2 lymph node dissection,and then Billroth Ⅱ or Roux-en-Y digestive tract reconstruction.Observation indicators:(1) surgical and postoperative situations;(2) detection of lymph node;(3) follow-up and survival situations.Measurement data with normal distribution were represented as x±s,and comparisons between groups were analyzed using the t test.Comparisons of count data were done using the chi-square test.Ordinal data were analyzed by the nonparametric test.Results (1) Surgical and postoperative situations:all 162 patients underwent successful surgery,without conversion to laparoscopic or open surgery,and pathological resection margins were confirmed as R0.Volume of intraoperative blood loss,levels of amylase in peritoneal drainage fluid at day 1,2 and 3 postoperatively,levels of serum amylase fluid at day 1,2 and 3 postoperatively were respectively (123±39) mL,(557± 181) U/L,(357± 127) U/L,(183±86) U/L,(181±47)U/L,(123±29)U/L,(85±22)U/L in the robotic group and (142±40)mL,(793±284)U/L,(497±199)U/L,(279±157) U/L,(218±45) U/L,(162±37) U/L,(120±31) U/L in the laparoscopic group,with statistically significant differences between groups (t =-3.015,-2.817,-2.364,-2.132,-2.372,-3.338,-3.720,P＜0.05).Cases with distal subtotal gastrectomy + D2 lymph node dissection and with total gastrectomy + D2 lymph node dissection,cases with Billroth Ⅱ and Roux-en-Y of digestive tract reconstruction,time of distal subtotal gastrectomy + D2 lymph node dissection,time of total gastrectomy + D2 lymph node dissection,cases with anastomotic leakage,pulmonary infection,wound infection or liquefaction and delayed gastric emptying,cases in grading Ⅱ,Ⅲ,Ⅳ and Ⅴ of postoperative complications,time of postoperative drainage-tube removal and duration of postoperative hospital stay were respectively 47,18,40,25,(222±37) minutes,(274±43) minutes,1,1,1,1,2,1,0,0,(6.5-± 1.5) days,(10.0±4.0) days in the robotic group and 74,23,69,28,(213±40) minutes,(262±39)minutes,2,4,1,0,4,1,0,1,(6.9±1.7)days,(10.0±5.0)days in the laparoscopic group,with no statistically significant difference between groups (x2=0.326,1.628,t =1.272,0.960,x2=2.501,Z=-1.342,t=-1.142,-0.115,P＞0.05).One and 1 patients in the robotic and laparoscopic groups who were complicated with esophagus-jejunum anastomotic leakage after total gastrectomy + Roux-en-Y anastomosis were cured by nutrition support therapy using feeding tube placement under gastroscopy,and 1 patient in the laparoscopic group who were complicated with gastrojejunal anastomosis leakage after distal subtotal gastrectomy +Billroth Ⅱ anastomosis received the second surgical exploration and jejunal feeding tube placement.Patients with pulmonary infection,wound infection or liquefaction and delayed gastric emptying were cured by conservative treatment.Levels of amylase in peritoneal drainage fluid and serum amylase fluid at day 1,2 and 3 postoperatively were not higher than 3 times of upper limit of normal,without treatment interventions.(2) Detection of lymph node:overall number of lymph nodes detected in the robotic and laparoscopic groups were respectively 36.82±13.41 and 35.21 ± 11.52,with no statistically significant difference between groups (t =0.786,P＞ 0.05).Results of further analysis showed that numbers of lymph node dissected in the 2nd station and upper region of pancreas in patients undergoing distal subtotal gastrectomy + D2 lymph node dissection were respectively 6.04±3.98,13.51±6.53 in the robotic group and 4.45±3.12,11.40±5.30 in the laparoscopic group,with statistically significant differences between groups (t=2.461,1.986,P＜0.05).Numbers of lymph node dissected in No 7 and 8 groups and upper region of pancreas in patients undergoing total gastrectomy + D2 lymph node dissection were respectively 5.44±2.63,2.92±1.87,10.81±4.78 in the robotic group and 3.11±1.82,1.62±1.33,7.76±3.34 in the laparoscopic group,with statistically significant differences between groups (t =3.340,2.689,2.522,P＜0.05).(3) Follow-up and survival situations:of 162 patients,148 were followed up for 2-14 months,with a median time of 8 months.During the follow-up,patients in the 2 groups had tumor-free survival.Conclusions Da Vinci robotic surgical system-assisted radical gastrectomy is safe and feasible.Compared with laparoscopy-assisted radical gastrectomy for locally advanced GC,it has advantages of clear vision of the local anatomy,less intraoperative bleeding,more numbers of lymph nodes dissected in the upper region of pancreas and lighter pancreatic injure,meanwhile,it has also certain operating advantages around the great vessels and in the deep and narrow spaces.