Objective:To introduce the operation process of laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction, and evaluate its feasibility, safety during perioperative period, and advantages of anastomosis.Methods:A total of 56 patients with gastric cancer who underwent laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction were selected as study subjects from Zhejiang Provincial People′s Hospital between May 2022 and June 2023. Gender, age, body mass index (BMI), tumor location, tumor stage, tumor type and other related indicators were collected. The main parameters during the operation process were collected, including operation time, anastomosis time, intraoperative blood loss, postoperative recovery status, exhaust time, feeding time, complications related to anastomosis, and length of hospital stay. The differences between other digestive tract reconstruction methods such as Overlap method, reverse puncture method, and handmade anastomosis were compared and analyzed.Results:A total of 56 patients with gastric cancer were included in this study. The anastomosis time of the tubular instrument group was (42.3±15.7)min, which was superior to the handmade anastomosis group ( P<0.05). The operation time of the tubular instrument group was (176.3±25.8)min, which was superior to other methods (all P<0.05). The intraoperative blood loss of the tubular instrument group was (75.68±20.34)ml, which was less than other methods (all P<0.05). The exhaust time of the tubular instrument group was (2.6±0.2)d, which was similar to the Overlap method ( P>0.05), but earlier than the handmade anastomosis method and the reverse puncture method (all P<0.05). The incidence of anastomotic leakage in the tubular instrument group was similar to the handmade anastomosis method, the reverse puncture method, and the Overlap method (all P>0.05). There were no significant differences in postoperative hospital stay, incision infection rate, and other complications related to anastomosis between groups (all P>0.05). Conclusions:The tubular instrument anastomosis method has a shorter operation time and a smaller incision compared to traditional laparotomy surgery. It has the advantages of laparoscopic assistance with intuitive and clear visualization during the operation, while also taking into account the convenience and safety of direct visualization under laparoscopy. It is a surgical method worthy of promotion.

Objective:To investigate the clinical effect of enteral nutrition support in the transformation therapy of advanced gastric cancer.Methods:Eighty-two patients with advanced gastric cancer treated by transformation in Zhejiang Provincial People′s Hospital from September 2019 to August 2021 were analyzed retrospectively. 41 patients in the observation group were treated with enteral nutrition support on the basis of routine transformation treatment; 41 patients in the control group received only routine transformation treatment. The nutritional related indexes such as prealbumin, total serum protein and albumin and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + were detected before treatment and on the 7th day after the end of 3-cycle transformation treatment, and the above indexes and transformation success rate of the two groups were compared. Results:There was no significant difference in prealbumin, total serum protein, albumin, CD4 + , CD8 + , CD4 + /CD8 + between the two groups before treatment (all P>0.05). On the 7th day after three cycles of transformation treatment, the above indexes in the observation group were higher than those in the control group, with significant difference (all P<0.05). The success rate of transformation in the observation group was higher than that in the control group ( P<0.05). Conclusions:The rational use of enteral nutrition support in the transformation treatment of patients with advanced gastric cancer can significantly improve the nutritional status and immune function of patients, increase the tolerance to chemotherapy and improve the success rate of transformation.

Gastrointestinal reconstruction is an important step in radical gastrectomy for gastric cancer. This article reviews the digestive tract reconstruction methods of total gastrectomy, distal gastrectomy, and proximal gastrectomy, and summarizes various functional preservation gastrectomy techniques that have been continuously developed in recent years. Finally, based on the author′s relevant experience, the surgical methods designed in total gastrectomy and distal gastrectomy are introduced.

OBJECTIVE To explore the effect of changing lifestyle diet in the treatment of laryngeal reflux disease(LRPD).METHODS A total of 92 patients with LRPD who received outpatient treatment in the Second Affiliated Hospital of Fujian Medical University from January 2022 to June 2023 were selected as the study control,divided into control group(46 cases)and treatment group(46 cases).The control group was treated with conventional acid suppression and gastric motogenic therapy.The treatment group was treated on the basis of the control group with giving guidance on lifestyle and diet.The changes of reflux symptom index scale(RSI)and reflux sign score scale(RFS)and the clinical efficacy of the two groups were compared 8 weeks and 12 weeks after treatment.RESULTS RSI total score was improved 8 weeks after treatment compared with before treatment in both RSI control group and treatment group(P＜0.05).The total RSI score of 12 weeks after treatment was improved compared with that of 8 weeks after treatment in both control and treatment groups(P＜0.05).The total RFS score at 8 weeks after treatment was improved in both control group and treatment group compared with before treatment(P＜0.05).Compared with 8 weeks after treatment,the total RFS score in both control group and treatment group was improved(P＜0.05).After 8 weeks of treatment,the total effective rate of the control group(60.9%)was compared with that of the treatment group(71.7%),and there was no significant difference between the two groups(χ2=1.335,P=0.513).After 12 weeks of treatment,the total effective rate of the control group(73.9%)was compared with the total effective rate of the treatment group(91.3%),and the difference between the two groups was statistically significant(χ2=6.226,P=0.044).CONCLUSION The change of lifestyle and diet should become an important part of the treatment of LRPD.By adjusting the unhealthy lifestyle and diet,the symptoms of patients can be significantly reduced and better clinical efficacy can be obtained.

Objective:To explore the effect of individualized strength training based on adjustable sandbags in early rehabilitation after total knee arthroplasty.Methods:From November 2019 to November 2020, convenience sampling was used to select 60 patients admitted to the Joint Surgery Department of the Affiliated Huaian First People's Hospital of Nanjing Medical University as the research object. According to the random number table, the patients were divided into the experimental group and the control group, 30 cases in each group. The patients in the control group were given routine rehabilitation after operation, and the patients in the experimental group received individualized strength training using adjustable sandbags in the early postoperative period. The Hospital for Special Surgery (HSS) and the range of motion of the knee joint were compared between the two groups on the third day, the seventh day after operation and at the time of discharge.Results:On the third and seventh days after operation and at the time of discharge, the HSS score and the range of motion of the knee joint in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:Early implementation of individualized strength training based on adjustable sandbags can promote postoperative rehabilitation of patients undergoing total knee arthroplasty, and improve their ability to adapt to early ambulation.

Objective To test the antimicrobial susceptibility of Staphylococcus aureus from children with impetigo,and to assess the differences in randomly amplified polymorphic DNA profiles between sensitive and resistant Staphylococcus aureus strains.Methods Secretion specimens were obtained from the impetiginous lesions of 178 children,and subjected to bacterial culture.The susceptibility of 162 Staphylococcus aureus isolates against 21 antibiotics was tested.Randomly amplified polymorphic DNA PCR(RAPD-PCR)was performed to characterize the genotype of Staphylococcus aureus.Results Totally,180 bacterial strains were isolated from 178 children with impetigo in Chengdu,including 162(90.00％)Staphylococcus aureus strains.Of the 162 Staphylococcus aureus strains,148 were methicillin sensitive Staphylococcus aureus(MSSA),14 methicillin resistant Staphylococcus aureus(MRSA).The most active antibiotic was minocycline,followed by teicoplanin,quinupristin,vancomycin and nitrofurantoin,while the resistance rate to penicillin was highest,followed by that to erythromycin,clindamycin,compound sulfamethoxazole and tetracycline.All the Staphylococcus aureus isolates were sensitive to fusidic acid,nitrofurantoin,vancomycin,minocycline and teicoplanin.According to RAPD-PCR,the 162 Staphylococcus aureus strains were divided into 8 genotypes,with the three most prevalent genotypes being Ⅲ(31.48％),Ⅱ(26.54％)and Ⅵ(25.93％),which accounted for 65.43％(106/162)in all the strains.The 148 MSSA strains fell into 8 genotypes,with genotype Ⅲ(50 strains,33.78％),Ⅵ(39 strains,26.35％)and Ⅱ(33 strains,22.30％)being the most prevalent genotypes;the 14 MRSA strains fell into 3 genotypes,i.e.,genotype Ⅱ(10 strains,71.43％),Ⅵ(3 strains,21.43％),and Ⅲ(1 strain,7.14％).Conclusions Staphylococcus aureus is the most prevalent pathogenic bacteria in children with impetigo in Chengdu area,which is highly sensitive to minocycline,teicoplanin and quinupristin,and falls into 8 genotypes according to RAPD-PCR with genotype Ⅲ being the most common genotype.

Objective:To explore the feasibility and therapeutic effect of Roux-en-Y anastomosis through a small incision in laparoscopic distal gastrectomy for gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of 34 patients who underwent laparoscopic distal gastrectomy for gastric cancer through Roux-en-Y anastomosis through small incisions in the Gastrointestinal and Pancreatic Surgery Department of the Zhejiang Provincial People′s Hospital from August 2022 to May 2023.Results:Among the 34 patients, there were 27 males and 7 females, aged (63.6±14.6)years old. All cases underwent surgery successfully and there were no cases of conversion to open surgery. The reconstruction time of the digestive tract was (30.74±3.29)minutes, the intraoperative bleeding volume was (60.29±29.59)ml, the intraoperative lymph nodes were cleaned (32.00±11.00), the incision length of the specimen was (5.88±0.98)cm, the postoperative exhaust time was (1.88±0.73)days, and the postoperative hospitalization time was (11.94±3.87)days. There were no postoperative cases of anastomotic leakage, anastomotic stenosis, bleeding, or unplanned reoperation in patients. After a postoperative follow-up of 3-12 months, there were no recurrence or death cases, and no postoperative reflux cases during the follow-up period.Conclusions:Laparoscopic distal gastrectomy with Roux-en-Y anastomosis through a small incision can effectively reduce postoperative complications, especially the occurrence of postoperative reflux. In addition, this surgical procedure can simplify the surgical steps, shorten the surgical time, promote postoperative recovery, and improve postoperative quality of life.