Objective To establish a simple and stable orthotopic segmental small bowel transplantation model in rats.Methods Eighty male SD rats were divided into donors and recipients.Orthotopic segmental small bowel transplantation was performed by end-to-side anastomosis between donor abdominal aorta tundish-shape patch with arteria mesenterica superior pedicle and abdominal aorta of the recipients; end-to-end anastomosis between the portal vein of the donors and the left renal vein of the recipients was done using the cuff technique ; the large part of the small bowel of the recipients was excised,and it was replaced by the segmental intestine of the donors.Results The operation time of the donors and recipients were (40 ± 5) minutes and (50 ±8)minutes,respectively.The warm ischemia time and cold ischemia time were (5 ± 2) minutes and (15 ± 5) minutes,respectively.The anastomosis time of arteries and veins were (5 ± 2) minutes and (4 ± 2) minutes,respectively.The survival time of 90.0％ (36/40) of rats was more than 10 days.Conclusion The modified rat model of orthotopic segmental small bowel transplantation is easy to manipulate,and has the advantages of short operation time,high survival rate and stability.

Background and purpose: Adenocarcinoma has become the most common histological type of lung cancer in recent years, and there is an increasing trend. This study aimed to investigate postoperative differences in clinical characteristics between adenocarcinoma and other types of non-small cell lung cancer (NSCLC) and prognostic factors of adenocarcinoma treated with surgery, and to provide a reference for the prevention and treatment of lung adenocarcinoma. Methods: The medical records of patients with NSCLC treated with surgery were selected from Jan. 2005 to Dec. 2014 at the Affiliated Tumor Hospital of Guangxi Medical University. This study compared the differences in clinical characteristics between adenocarcinoma and other types of NSCLC, and analyzed the influence of prognostic factors of lung adenocarcinoma with log-rank test and COX model. Results: With 451 cases of adenocarcinoma, the gender ratio was 1.29:1, the average age was 56.02 years old, the lymph node metastasis rate was 53.22% (240/451), and the median survival time was 44 months. There were statistical differences between adenocarcinoma and other types of NSCLC in gender ratio (P<0.001), average age (P=0.039), lymph node metastasis rate (P=0.012), and median survival time (P<0.001). In multivariate analysis, PTNM stage (P<0.001), gender (P=0.032), preoperative diabetes (P=0.019), subcarinal lymph node metastasis (P=0.013), number of lymph node metastasis (P<0.001), postoperative chemotherapy (P=0.040) or targeted therapy after surgery (P<0.001) were independent prognostic factors. Conclusion:Compared with other types of NSCLC, adenocarcinoma showed the characteristics of higher incidence of constituent ratio in women, lower average age, higher rate of lymph node metastasis and poor prognosis. PTNM stage, gender, pre-operative diabetes, subcarinal lymph node metastasis, number of lymph node metastasis, postoperative chemotherapy or targeted therapy are important influencing factors that can affect the prognosis of adenocarcinoma following the surgical procedure.

Objective To assess the validity of transanal local excision for stage Ⅰ low rectal carcinoma.Methods The clinical data of 93 patients with stage Ⅰ low rectal carcinoma who underwent transanal excision (group A,n=45)or radical resection(group B,n=48)were retrospectively analyzed.Twenty-four T1 patients and 21 T2 patients in group A received postoperative adjuvant radiation therapy and adjuvant chemoradiotherapy,respectively.All patients in group B received radical surgery only.The 5-year survival rates,recurrence rates,and postoperative complications between the 2 groups were compared.Results The 5-year survival rates were 100%(24/24)for T1 patients,86%(18/21)for T2 patients in group A,and 100%(18/18)for T1 patients,93%(28/30)for T2 patients in group B,with no significantly statistical difference between the 2 groups(P＞0.05).The recurrence rates were 4%(1/24)for T1 patients,19%(4/21)for T2 patients in group A,and 0(0/18)for T1 patients,7%(2/30)for T2 patients in group B,with no significance between the 2 groups(P＞0.05).The incidence of postoperative complications in group A was 2%(1/45),which was significantly lower than that of 15%(7/48))in group B(P＜0.05).Conclusions Transanal local excision of early low rectal carcinoma,combined with postoperative chemotherapy for T1 patients or chemoradiotherapy for T2 patients, results in a low complication rate and good sphincter function,and provides satisfactory local control and 5-year survival rates.

Objective To evaluate effects of alimentary reconstruction procedures (integral continual jejunal interposition, Billroth Ⅱ and isolated jejunal interposition) after subtotal gastrectomy on postoperative plasma gastrin, motilin and cholecystokinin. Methods Twenty-four dogs were divided into 3 groups undergoing distal subtotal gastrectomy and three different digestive tract reconstruction (integral continual jejunal interposition, Billroth Ⅱ and isolated jejunal interposition). The concentration of plasma gastrin, motilin and cholecystokinin were detected by enzyme-linked immunosorbent assay before and after operation. Results Two months after operation, plasma gastrin level of the integral continual jejunal interposition group (2. 2 ±0. 7 ) ng/L, ( 3.9 ± 0. 8 ) ng/L was significantly lower than that of preoperative both in fasting and postprandial state (3.8 ± 1.0) ng/L, (5.3 ± 1.6) ng/L, all P ＜0.05, but was significantly higher than other two groups in postprandial state (2. 7 ± 1.0) ng/L, (3.6 ±0. 6) ng/L, P ＜0. 05. Two months after operation, plasma motilin concentration of integral continual jejunal interposition group (577 ±204) ng/L, (1003 ± 209) ng/L were significantly higher than that of preoperative both in fasting and postprandial (429 ± 128) ng/L, (854 ± 218 ) ng/L, P ＜ 0. 05. The postoperative plasma motilin of integral continual jejunal interposition group ( 1003 ± 209 ) ng/L was significantly higher than other two groups in postprandial state (840 ±205) ng/L, (986 ± 189) ng/L, P ＜0. 05. Two months after operation,plasma cholecystokinin concentration of integral continual jejunal interposition group ( 19.6 ± 2.0 ) ng/Lwere significantly higher than that of preoperative both in postprandial ( 19.0 ± 2. 0) ng/L, P ＜ 0. 05. The postoperative plasma cholecystokinin of integral continual jejunal interposition group ( 19. 6 ± 2. 0) ng/L was significantly lower than other two groups (22.2 ± 2. 1 ) ng/L, (20. 1 ± 2. 5 ) ng/L, P ＜ 0. 05. Conclusion Integral continual jejunal interposition after distal gastrectomy maintains the postoperative plasma motilin and gastrin in a relatively higher level and decreases the concentration of plasma cholecystokinin.

Objective:To investigate the clinical efficacy of total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction.Methods:The data of 18 patients who underwent total laparoscopic resection of gastric stromal tumors with cosmetic suture reconstruction from December 2020 to May 2023 in Zhejiang Provincial People′s Hospital were collected retrospectively, and their clinical efficacy was analyzed.Results:Twelve patients were asymptomatic and the tumor was found during physical examination. All patients underwent total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction without conversion to open surgery. The time to resume liquid diet was 1-3(1.67±0.35)days, the postoperative hospital stay was 4-12(6.89±2.54)days, and no postoperative complications occurred. Among them, 12 cases were at low risk and 6 cases were at medium risk. CD117 and DOG-1 were positively expressed in all cases. Four out of six patients at medium risk underwent genetic testing, and two patients with c-Kit gene Lys550-Val560 mutation were treated with Gleevec therapy after surgery. Gastrography performed one month after surgery showed that the shape of the stomach was similar to the preoperative shape, with good motility and unimpeded emptying.Conclusions:Total laparoscopic resection of gastric stromal tumors combined with cosmetic suture reconstruction can reduce postoperative gastrointestinal dilatation, esophageal and pyloric stenosis, and has a certain clinical value.

OBJECTIVE To explore mecha-nisms of imperatorin on regulating P-glycoprotein(P-gp)in blood-brain barrier(BBB)based on net-work pharmacology combined with in vitro experi-ment.METHODS Drug targets were predicted using the Pharmapper and Swiss targets data-bases;disease targets were obtained through the Genecards database;intersections between drugs and disease targets were screened by Cytoscape software;the obtained core targets were used to construct protein-protein interaction(PPI)network,gene ontology(GO)functions,and Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis.The effects of imperatorin(20,50,100 μ mol·L-1)on P-gp activity were monitored in hCMEC/D3in vitro BBB model,and the effects of imperatorin on the expression of target proteins were verified using Western blot method.RESULTS 55 drug targets and 3102 disease targets were obtained from the network pharmacology screening,and 37 core targets were obtained after the combination.Enrichment analysis showed that core targets were closely related to chemical synaptic trans-mission regulation,neurotransmitter receptor activity,proteinkinaseregulationactivity,G protein-coupled receptor signaling pathway,neural active ligand receptor interaction pathway,PI3K-Akt sig-naling pathway,VEGF signaling pathway,etc..In vitro experimental validation suggested that all tested concentration groups of imperatorin signifi-cantly reduced the activity and expression of P-gp,which were achieved by significantly downregu-lating the phosphorylation levels of PI3K and Akt,and repressing the expression of VEGFR2 pro-tein.CONCLUSION Network pharmacology was used to predict the core targets and signaling pathways of imperatorin on regulating P-gp in BBB and relevant validation was conducted through in vitro experiments,providing a refer-ence basis for further exploration of the mecha-nisms of imperatorin on regulating P-gp in BBB.

Objective To invesitgate the epidemiological characteristics of common allergens in 10 664 patients with allergic diseases in Zhengzhou area.Methods A total of 10 664 patients visited our hospital and underwent serum allergen screening during January 2013 and August 2021 were selected,and their serum sIgE results were retrospectively analyzed.Results The total positive rate of sIgE to allergens in 10 664 patients was 69.82%.The positive rate of sIgE to inhalant allergens was significantly higher than that to in-gestive allergens(χ2=99.15,P＜0.01).The top three inhalant allergens were grass and tree combination,dust mite combination,and cockroach.The top three ingestive allergens were egg protein,milk,and seafood combination.The positive rate of sIgE to ingestive al-lergens in males was significantly higher than that in females(χ2=8.18,P＜0.01).The highest positive rate of sIgE to ingestive aller-gens was found in the early childhood period(χ2=125.92,P＜0.05).The highest positive rate of sIgE to inhalant allergens was found in the school-age and preschool periods(χ2=283.76,P＜0.01).The proportions of sIgE to cockroach and house dust mite showed a de-creasing trend year by year,while the proportions of sIgE to milk,peanut,lamb,and seafood combination showed an increasing trend year by year.Conclusion The top three inhalant and ingestive allergens in Zhengzhou area are grass and tree combination,dust mite,cockroach and egg protein,milk,seafood combination,respectively.In recent years,the allergies to milk,peanut,lamb,and seafood should be paid attention.

Objective To investigate the effects of adoptive reinfusion of regulatory T cell (Treg) on the recovery of islet function and graft survival time after islet allograft transplantation. Methods The diabetic model was established using C57BL/6 mice as recipients, and Balb/c mice were chosen as donors for islet allografts transplantation beneath the renal capsule. The recipient mice were divided into 3 groups and 3 mice in each group according to different processing Methods: Treg experiment group (Treg group, 1×10⁶ Treg cells were injected via tail vein at 1 d before operation), positive control group [sirolimus (SRL) group, SRL at a dose of 300 μg/(kg·d) was intragastrically given every day from 1 d before operation] and blank control group (control group, an equivalent volume of normal saline was intragastrically given every day from 1 d before operation). Enzyme-linked immune absorbent assay (ELISA) was used to detect the changes of blood glucose and C-peptide in mice within 14 days after transplantation. In vivo imaging technique was used to dynamically monitor the survival of mice within 14 days after transplantation. Results In each group, the blood glucose levels at postoperative 3 d were significantly decreased compared with those before transplantation (all P < 0.001). At postoperative 1 d, the C-peptide levels showed an explosive rise to varying degree in each group. At postoperative 3 d, the C-peptide levels in each group were significantly higher than that before operation (all P < 0.001). At the end of the observation period at 14 d after operation, the C-peptide levels in the SRL and Treg groups were (427±50) pmol/L and (833±57) pmol/L, relatively higher than that in the control group. But the blood glucose levels were (14.5±0.5) mmol/L and (12.1±0.6) mmol/L, significantly lower than that in the control group (all P < 0.001). Compared with the SRL group, the explosive release amount of C-peptide was significantly lower, the declining trend was more remarkably stable, and the C-peptide level was considerably higher in the Treg group at the end of the observation period (all P < 0.001). At postoperative 14 d, the grafts were almost completely apoptotic in the control group, over 50% of the grafts survived in the SRL group, and over 80% of the grafts survived in the Treg group. Conclusions Adoptive reinfusion of Treg cells can effectively protect islet grafts, prolong the survival time of grafts, and maintain the normal levels of blood glucose and C-peptide in the recipient mice.

Objective:To study the feasibility and safety of redo laparoscopic operations for choledochojejunostomy stenosis after minimally invasive pancreaticoduodenectomy.Methods:The clinical data of 7 patients with choledochojejunostomy stenosis which developed after minimally invasive pancreaticoduodenectomy who were treated with redo laparoscopic surgery from August 2019 to July 2021 at the Division of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital were retrospectively studied. There were 3 males and 4 females, with the age of (41.7±4.3) (ranged 27 to 54) years. The timing of reoperation, intraoperative blood loss, and postoperative complications were analyzed. An anastomotic restenosis was looked for on followed-up by outpatient interviews or phone calls.Results:The time interval of between diagnosis of the first postoperative anastomotic stenosis and surgery was 3-20 months, with a median of 9 months. Of the 7 patients, 5 patients underwent laparoscopic biliary anastomotic resection and reconstruction, and the remaining 2 patients underwent laparoscopic exploration of the anastomosis, removal of intrahepatic bile duct stones, and re-anastomosis. The median operative time was 180 (150-350) minutes. The median postoperative hospital stay was 6 (ranged 5 to 21) days. The intraoperative blood loss was 50 (ranged 20 to 300) ml. There was no intraoperative blood transfusion. One patient developed grade B biliary leakage after the surgery, improved with puncture and drainage. The remaining patients had no serious complications. There was no mortality. The median follow-up was 8 (ranged 1 to 23) months, during which no recurrence of biliary anastomotic stenosis occurred in all these patients.Conclusion:For patients with biliary anastomotic stenosis after minimally invasive pancreaticoduodenectomy, redo laparoscopic operations offered an alternative treatment option with satisfactory outcomes.

Objective:To compare the perioperative outcomes between robotic pancreaticoduodenectomy(RPD)and laparoscopic pancreaticoduode-nectomy(LPD)in patients aged ≥65 years. Methods:The clinical data of 130 patients aged ≥65 years who received minimally invasive pancreaticoduodenectomy(MIPD)at Department of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People's Hospital from January 2019 to December 2022 were retrospectively analyzed.The patients were divided into the RPD group(n=66)and the LPD group(n=64)according to the operation method,and the perioperative clinical data were compared between the 2 groups. Results:Compared with the LPD group,the average age of patients in the RPD group was higher than that of the LPD group[(71.95±4.73)years vs(70.39±3.9)years,P＜0.05];the RPD group had more patients with diabetes(39.4％vs 18.8％,P＜0.05)and cardiopulmonary diseases(37.9％vs 17.2％,P＜0.05);the RPD group had shorter operation time[(272.91± 68.38)min vs(362.81±78.24)min,P＜0.05]and less intraoperative blood loss[median(range):1 00 mL(50-200 mL)vs 1 50 mL(1 00-200 mL),P＜0.05)];the RPD group had higher incidence of chylous fistula(1 2.1％vs 1.6％,P＜0.05)but lower incidence of surgical morbidity(37.9％vs 46.9％),serious complications(19.7％vs 34.4％),postoperative pancreatic fistula(12.1％vs 17.2％),biliary fistula(3.0％vs 3.1％),abdominal infection(10.6％vs 14.1％),postoperative bleeding(4.5％vs 4.5％),and postoperative cardiopulmonary complications(1 2.1％vs 20.3％)with no statistically significant difference(P＞0.05);the RPD group waited shorter time before restarting diet[(3.97±1.59)d vs(5.34±2.56)d,P＜0.05]. Conclusion:MIPD is safe and feasible in patients aged ≥65 years.The incidence of perioperative complications is similar between the 2 groups.Compared with LPD,RPD has shorter operation time,less intraoperative blood loss,and shorter duration before restarting diet after operation,which has certain clinical advantages.