With the development of surgery and technology, robot-assisted pancreatic surgery has gradually become a popular choice for surgeons, and is favored by patients and their families. As the first pancreatic disease treatment center in China to carry out robot-assisted pancreatic surgery, the author's team has unique experience and insight into robot-assisted pancreatic surgery. With the updating and domestication of surgical robots, the domestic multi-port robot-assisted surgical system has begun to be applied in clinical practice. The paper gave an overview of the development of domestic multi-port robotic surgical system in the clinical practice of pancreatic surgery.

Objective To observe the effects of electroacupuncture on intestinal flora and serum inflammatory factors in rabbit model with rheumatoid arthritis(RA);To explore the mechanism of its therapeutic effect on RA.Methods RA model rabbits were established by ovalbumin induction combined with Freund's complete adjuvant,and the rabbits after successful modeling were randomly divided into model group,probiotic group and electroacupuncture group,with 6 rabbits in each group.Another 6 rabbits were set as the normal group.The electroacupuncture group received electroacupuncture at the bilateral"Zusanli"and"Dubi"for 30 minutes,the probiotic group was given probiotic capsules solution(14.5 mg/kg)by gavage,once a day,for two consecutive weeks.The knee joint circumference and pain threshold of rabbits were measured,histopathological morphological changes of colonic tissue and synovial tissue ws observed by HE staining,16S rDNA sequencing was used to analyze structural changes of intestinal flora,the contents of TNF-α,IL-1β and IL-6 in serum were detected by ELISA.Results Compared with the normal group,the circumference of knee joint of rabbits in the model group increased significantly,the pain threshold was significantly decreased(P<0.01);the colonic mucosal damage was serious,the goblet cells were missing,a large number of inflammatory cells were infiltrate;the joint capsule synovial surface was rough,the synovial cell layer was hyperplasia and thickening,the synovial tissue inflammatory cell infiltration was obvious;the number and evenness of gut microbiota species decreased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes decreased(P<0.05,P<0.01),the relative abundance of Desulfobacteria increased(P<0.01),while the relative abundance of Campylobacter,Lawsonella,and Pseudomonas increased(P<0.01),while the relative abundance of Heshanomonas and Herbaspirillum decreased(P<0.01);the contents of serum TNF-α,IL-1β and IL-6 increased(P<0.01).Compared with the model group,the knee joint circumference of the probiotic group and the electroacupuncture group decreased,the pain threshold increased(P<0.01,P<0.05);the degree of intestinal mucosal damage was reduced,the goblet cells were basically arranged neatly,the inflammatory cell infiltration was reduced;synovial cells proliferation and thickening decreased,with a small amount of inflammatory cell infiltration;the number and evenness of gut microbiota species increased,while the relative abundance of Proteobacteria,Firmicutes,and Bacteroidetes increased(P<0.05,P<0.01),the relative abundance of Desulfobacteria decreased(P<0.01),while the relative abundance of Campylobacter,Lawsonella and Pseudomonas decreased(P<0.01),the relative abundance of Heshanomonas and Herbaspirillum increased(P<0.05,P<0.01);the contents of serum TNF-α,IL-1β and IL-6 significantly decreased(P<0.01).Conclusion Electroacupuncture can significantly improve the symptoms of RA rabbits and reduce the inflammatory reaction in synovial tissue of joint,and the mechanism may be related to the regulation of intestinal flora structure.

In order to provide basic information for the utilization and development of famous classical formulas containing Bletillae Rhizoma， this article systematically analyzes the historical evolution of the name， origin， harvesting and processing of Bletillae Rhizoma by reviewing the ancient materia medica， prescription books， medical books and modern literature. The research results showed that Baiji（白及） was the main name， some scholars took Baiji（白芨） as its main name， and there were many other names such as Baiji（白给）， Baigen（白根）， Baiji（白苙）. The mainstream source of Bletillae Rhizoma was the tubers of Bletilla striata， and drying， large， white， solid， root-free and skin removed completely were the good quality standards. With the promotion of wild to cultivated medicinal materials， there were certain differences between their traits， and the quality evaluation indexes should be adjusted accordingly. The origin of records in the past dynasties was widely distributed， with Guizhou and Sichuan having high production and good quality in modern times. The harvesting period is mostly in spring and autumn， and harvested in autumn was better. The processing and processing technology is relatively simple， and it was used fresh or powdered in past dynasties， while it is mainly sliced for raw use in modern times. Based on the results， it is suggested that the tubers of Bletilla striata of Orchidaceae should be used in the famous classical formulas， and it should be uniformly written as Baiji（白及）. And if the original formula indicates the requirement of processing， it should be operated according to the requirement， if the requirement of processing is not indicated， it can be used in raw form as medicine.

Centrifugal blood pumps drive blood flow by regulating blood flow rate,and have been widely used in clinical applications,including extracorporeal membrane oxygenation(ECMO),cardiopulmonary bypass(CPB),and extracorporeal circulation carbon dioxide removal(ECCO2R).However,because different structures and different forms of centrifugal pumps have different requirements for blood extracorporeal circulation in clinical application scenarios,blood pumps face different application conditions in clinical use.In this study,the effects of different structures of centrifugal pumps and different working conditions on blood damage are summarized for reference by relevant institutions and R&D personnel.

For pancreatic neoplasms, the current clinical treatment strategy is mainly using standard surgical methods, including pancreaticoduodenectomy, distal pancreatectomy with splenectomy, and total pancreatectomy. Standard surgical methods require a larger resection, including resection of some surrounding organs and a large amount of pancreatic parenchyma. The endocrine and exocrine functions of the pancreas are easily damaged. Moreover, since the standard surgical procedure involves the reconstruction of the digestive tract at multiple anastomoses, there is a high risk of pancreatic, biliary, and intestinal fistulas occurring postoperatively. Therefore, function-preserving pancreatic surgery is recommended for some benign and low-grade pancreatic neoplasms. This type of surgery can treat pancreatic diseases while preserving more peripancreatic organs, pancreatic parenchyma and relatively complete digestive tract continuity, thereby improving the patient′s short-term and long-term quality of life. In addition, with the development of laparoscopy and da Vinci robotic technology, minimally invasive technology-assisted pancreatic surgery has been carried out in clinical practice. They have been shown to be sufficiently safe and effective. This article reviews several common clinical pancreatic function-preserving surgical methods and their corresponding clinical applications and technical development status from the perspectives of preserving more peripancreatic organs, preserving more pancreatic parenchyma, and promoting pancreatic function recovery.

For pancreatic neoplasms, the current clinical treatment strategy is mainly using standard surgical methods, including pancreaticoduodenectomy, distal pancreatectomy with splenectomy, and total pancreatectomy. Standard surgical methods require a larger resection, including resection of some surrounding organs and a large amount of pancreatic parenchyma. The endocrine and exocrine functions of the pancreas are easily damaged. Moreover, since the standard surgical procedure involves the reconstruction of the digestive tract at multiple anastomoses, there is a high risk of pancreatic, biliary, and intestinal fistulas occurring postoperatively. Therefore, function-preserving pancreatic surgery is recommended for some benign and low-grade pancreatic neoplasms. This type of surgery can treat pancreatic diseases while preserving more peripancreatic organs, pancreatic parenchyma and relatively complete digestive tract continuity, thereby improving the patient′s short-term and long-term quality of life. In addition, with the development of laparoscopy and da Vinci robotic technology, minimally invasive technology-assisted pancreatic surgery has been carried out in clinical practice. They have been shown to be sufficiently safe and effective. This article reviews several common clinical pancreatic function-preserving surgical methods and their corresponding clinical applications and technical development status from the perspectives of preserving more peripancreatic organs, preserving more pancreatic parenchyma, and promoting pancreatic function recovery.

Objective:To explore the safety and efficacy of Tumai domestic multi-port robot-assisted surgery system in the clinical application of distal pancreatectomy in pancreatic tumor patients.Methods:A prospective, single-center, single-arm exploratory study was conducted. A total of 20 patients who underwent robot-assisted pancreatic body-tail resection in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from March 2023 to November 2023 were enrolled, including 13 males and 7 females, aged (57.9±11.2) years. All the patients underwent robot-assisted distal pancreatectomy with Tumai multi-port surgical robot. Clinical data of complications, intraoperative blood loss, operative time, postoperative drainage tube retention time, and postoperative pathology were collected and statistically analyzed.Results:All the 20 patients underwent surgery successfully. Only 1 patient (5.0%) was diagnosed with pancreatic neuroendocrine tumor (G1 stage), and the rest were benign pancreatic tumors, including serous cystadenoma and mucinous cystadenoma. No instrument-related organ or blood vessel injury occurred, no intraoperative complications occurred. Of 7 patients (35.0%) had postoperative complications, including 3 infections, 3 abdominal effusion, and 1 hypokalemia. According to the Clavien-Dindo grading, all the cases were grade Ⅰ except 1 case with grade Ⅱ abdominal effusion. No serious complications above grade Ⅲ occurred. The intraoperative blood loss of the 20 patients was 100(20, 200) ml, the operative time was (125.7±76.9) min, and the postoperative retention time of drainage tube was (7.9±3.4) d.Conclusion:Tumai domestic multi-port robot-assisted surgery system has acceptable safety and efficacy in the clinical application of distal pancreatectomy.

Objective : To investigate the changes of liver renin⁃angiotensin (RAS) system as well as its relationship with liver function in endotoxemia rats. Methods : Totally 90 rats were randomly divided into control group and 2 , 4 , 8 , 12 , 24 , 48 , 72 h and 7 d after injection group , which were prepared for sepsis model by tail vein injection of LPS except for the control group. Animals in the control group were collected samples at 8 h after injection , while animals in the model group were collected samples at each time points (2 , 4 , 8 , 12 , 24 , 48 , 72 h and 7 d) . Heart blood was collected to measure liver markers alanine amine aminotransferase ( ALT) , aspartate aminotransferase (AST) , lactate dehydrogenase (LDH) , RAS markers renin⁃angiotensin (PRA) , angiotensin converting enzyme (ACE) and angiotensin Ⅱ (Ang Ⅱ ) . Liver tissues were extracted to observe the pathology characteristics and detect PRA , ACE , Ang Ⅱ and angiotensin type 1 receptor ( AT1R) mRNA. Results : The levels of AST , ALT and LDH in the model group gradually increased after LPS injection , and AST and LDH in the model group were higher than those in the control group at 4 ~ 48 h , ALT in the model group was higher than that in the control group at 2 to 48 h , and the differences were statistically significant (P < 0. 05) . The circle and liver PRA level in the model group increased rapidly after injection , which was higher than that in the control group at 2 to 48 h. The circle and liver levels of ACE and Ang Ⅱ increased after injection too , which were both higher than those in the control group at 2 to 28 h , and the difference was statistically significant ( P < 0. 05 ) . The expression of AT1R mRNA in the model group gradually increased after injection , which was higher than that in the control group at 4 to 48 h , and the difference was statistically significant ( P < 0. 05 ) . Conclusion Liver function damage caused by endotoxemia may be related to the activation of local RAS in the liver.

Background: Unintended intraoperative hypothermia is a common complication of general anesthesia surgery, which can cause pain, coagulation dysfunction, wound infection, delayed recovery, and other adverse consequences. There are few studies related to intraoperative hypothermia during endoscopic retrograde cholangiopancreatography (ERCP). Aims: To analyze the risk factors of intraoperative hypothermia during ERCP under general anesthesia and establish a predictive model. Methods: A total of 121 patients underwent ERCP under general anesthesia from September 2021 to November 2021 at Shanghai General Hospital were recruited, and relevant clinical data were collected. Logistic regression analysis was used to screen risk factors, and a predictive model was constructed. The model was externally validated by independent datasets with ROC curve and Hosmer⁃Lemeshow goodness of fit test. Results: A total of 114 patients were enrolled in modeling group. The incidence of intraoperative hypothermia was 11.40% (13/114). There were more women in the hypothermia group (P<0.05). The temperature of entering the operating room and operating room temperature were relatively lower in the hypothermia group (P<0.05). Gender was an independent risk factor for intraoperative hypothermia in ERCP under general anesthesia (P<0.05). The predictive model constructed by using gender and temperature of entering the operating room screened by Logistic regression analysis had a good discrimination and calibration, area under the ROC curve by external validation was 0.78. Conclusions: Gender and temperature of entering the operating room can effectively predict the occurrence of intraoperative hypothermia and assist perioperative monitoring and management.