Objective:To evaluate a transhiatal tunnel flap designed to reconstruct the cardiac functional structure in proximal gastric cancer patients in our center.Methods:A descriptive case study method was used to select the data of 11 patients undergoing surgery for upper gastric cancer from Jan to Jul 2024. After laparoscopic dissection is completed, the esophagus is transected 2 cm from the upper edge of the tumor and the specimen is removed. The distance from the lower edge of the tumor is 5 cm. The cutting width is 4 cm, and the length of sleeve distal stump stomach is 20 cm. A seromuscular flap tunnel was made with a length of 2 cm and a width of 2 cm, 2 cm away from the top of the remnant stomach. The digestive tract was reconstructed using the Overlap hybridization method.Results:The median operation time was 175 (139-285) minutes. The median muscle flap production time and reconstruction time was 10.5 (5.5-21.0) minutes and 15.0 (11.8-33.6) minutes, respectively. The median blood loss is 50 (20-100) ml. The median postoperative hospitalization was 8 (6-25) days. The median tumor size was 2.5 (1.0-4.0) cm, and 31 (15-52) lymph nodes were dissected. The median follow-up after surgery was 3.5 (0.7-6.0) months, and no tumor recurrence or metastasis was found. Postoperative anastomotic leakage (Clavien-Dindo grade Ⅱ) occurred in one case, and there was no perioperative death. The Visick score of the whole group was 1 point in 8 cases and 2 points in 3 cases, and there was no anastomotic stenosis. Reflux esophagitis (Los Angeles classification grade B) was found in 1 case after gastroscopy, and the symptoms were relieved by conservative treatment.Conclusion:The transhiatal tunnel flap arthroplasty method has high surgical safety, low reconstruction difficulty, and an reliable anti-reflux effect.

Objective:To evaluate a transhiatal tunnel flap designed to reconstruct the cardiac functional structure in proximal gastric cancer patients in our center.Methods:A descriptive case study method was used to select the data of 11 patients undergoing surgery for upper gastric cancer from Jan to Jul 2024. After laparoscopic dissection is completed, the esophagus is transected 2 cm from the upper edge of the tumor and the specimen is removed. The distance from the lower edge of the tumor is 5 cm. The cutting width is 4 cm, and the length of sleeve distal stump stomach is 20 cm. A seromuscular flap tunnel was made with a length of 2 cm and a width of 2 cm, 2 cm away from the top of the remnant stomach. The digestive tract was reconstructed using the Overlap hybridization method.Results:The median operation time was 175 (139-285) minutes. The median muscle flap production time and reconstruction time was 10.5 (5.5-21.0) minutes and 15.0 (11.8-33.6) minutes, respectively. The median blood loss is 50 (20-100) ml. The median postoperative hospitalization was 8 (6-25) days. The median tumor size was 2.5 (1.0-4.0) cm, and 31 (15-52) lymph nodes were dissected. The median follow-up after surgery was 3.5 (0.7-6.0) months, and no tumor recurrence or metastasis was found. Postoperative anastomotic leakage (Clavien-Dindo grade Ⅱ) occurred in one case, and there was no perioperative death. The Visick score of the whole group was 1 point in 8 cases and 2 points in 3 cases, and there was no anastomotic stenosis. Reflux esophagitis (Los Angeles classification grade B) was found in 1 case after gastroscopy, and the symptoms were relieved by conservative treatment.Conclusion:The transhiatal tunnel flap arthroplasty method has high surgical safety, low reconstruction difficulty, and an reliable anti-reflux effect.

Objective:To evaluate the safety and feasibility of the laparoscopic indocyanine green (ICG) fluorescence imaging during the sentinel node navigational surgery for the early gastric cancer.Methods:Patients with <4 cm early gastric cancer were chosen. 0.5 ml ICG (2.5 mg/ml) was preoperatively injected into submucosa around the lesion in four points by the endoscopy. The sentinel lymph node basin including the stained tissue and lymph node (LN) were completely resected guided by the fluorescence mapping under ICG laparoscopy. The specimen was inspected by frozen pathology section. The radical gastrectomy was dependent on the pathology result.Result:Between 2019 and 2021, a total of 18 patients were included in the final analysis. Most tumors (16/18) located in the middle or distal stomach. Median tumor size was 2.0 cm. Lymph vessel invasion was revealed in five cases and perineural invasion in three cases. According to AJCC tumor grading system, tumor depth was classified as Tis in 2 cases, T1a in 5 cases and T1b in 11 cases. Lymph node metastasis (LNM) was revealed in four patients (4/18, 22%). Median sentinel lymph node basins per patient were 2 (range, 1-5). An average 6 (range, 2-13) LNs were harvested in each case, including 6 (1-13) ICG stained LNs and 1 (0-5) non stained LNs. All of four LNM patients were detected by sentinel node navigational surgery. The rate of the sensitivity and accuracy were 100% and 100%, respectively. The median follow-up for the entire group was 58.3 months (0.3-59.9 months), with no recurrence or metastasis observed in any patient.Conclusion:The sensitivity and accuracy of the laparoscopic indocyanine green fluorescence imaging during the sentinel node navigational surgery were satisfactory.

Objective:Efficacy and safety of robot-assisted laparoscopic adrenalectomy as a treatment for large adrenal tumors.Three-dimensional(3D) reconstruction can effectively assist in preoperative planning of robotic adrenalectomy and reduce potential complications.Methods:We retrospectively reviewed the relevant information of patients who had a preoperative 3D reconstruction and underwent RA for adrenal masses larger than 10 cm. Thirteen male patients and sixteen female patients were included. The median(range) age was 43(25, 57) years old and the median tumor diameter was 12.1(10.3, 16.2) cm. The patients underwent preoperative CT enhancement scanning, and three-dimensional images were reconstructed based on the examination data. Robot-assisted laparoscopic adrenalectomy was performed under general anesthesia in 29 cases in this cohort.Results:All surgeries were completed successfully without major complications such as massive bleeding, secondary surgery, or even patient death. The median operative time was 131 (80, 245) min, and the median intraoperative bleeding was 330 (50, 2 200 ml) ml. 9 patients received blood transfusions. There were 11 cases of pheochromocytoma (37.9%), 10 cases of adenocarcinoma (34.5%) as well as 2 cases of teratoma (6.9%) and 6 cases of cortical carcinoma (20.7%). The patients were followed up for a median of 30 months after surgery. Except for 3 cases lost to follow-up and 2 patients with cortical cancer who developed recurrence or metastasis after surgery and died at 16 and 23 months after surgery, respectively, the remaining 24 cases have survived to date.Conclusions:RA is a safe and effective treatment for huge adrenal tumors. The 3D reconstruction could help the preoperative planning of RA and reduce potential complications.

Background The metabolites and metabolic pathways of hand-arm vibration syndrome have not yet been elucidated. Objective To investigate the effect of local vibration on endogenous metabolites in rat serum by metabolomic analysis, to preliminarily explore the potential metabolic pathway of endogenous metabolites, so as to provide evidence for further research on the mechanism of hand-arm vibration syndrome. Methods Thirty-two SPF male SD rats, (211.3±11.1) g, 7−8 weeks of age, were selected and randomly divided into three groups: control group (14 rats, without vibration), 7 d vibration group (9 rats, continuously vibration for 7 d), and 14 d vibration group (9 rats, continuous vibration for 14 d). The vibration rats were vibrated every day for 4 h, the frequency weighted acceleration was 4.9 m·s⁻², the vibration frequency was 125 Hz, and the vibration direction was one-way vertical vibration. The control group had the same conditions except not contacting vibration. After the vibration exposure, the blood samples taken from the abnormal aorta of rats were collected, and the changes of rat serum metabolome were analyzed by ultra-performance liquid chromatography-tandem time-of-flight mass spectrometry. Principal components analysis (PCA) was used to explore changes in rat serum metabolic profile, and orthogonal partial least squares-discriminant analysis (OPLS-DA) was used to screen out differential metabolites. Combined with online databases, a metabolic pathway enrichment analysis of differential metabolites was performed. Results The PCA analysis showed that compared with the control group, the rat serum metabolic profiles in the 7 d group and the 14 d group were clearly differentiated, and the rat serum metabolic profiles in the 7 d group and the 14 d group partially overlapped. The OPLS-DA analysis showed significant differences between groups. The main parameters were: model interpretation rate R²Y=0.914, model predictive ability Q²=0.58. The OPLS-DA analysis screened out 26 and 119 differential metabolites from the 7 d group and the 14 d group respectively, and there were 24 common differential metabolites between the 7 d group and the 14 d group. The metabolomic pathway analysis showed that local vibration-induced changes in rat serum metabolism were mainly related to arachidonic acid metabolism in the 14 d group, among which the metabolites with significant effects were arachidonic acid, prostaglandin E₂, and prostaglandin D₂. Conclusion Local vibration could affect the normal metabolism in rats, and the metabolic pathway with significant influence is arachidonic acid metabolism after a 14 d exposure and the involved metabolites are arachidonic acid, prostaglandin E₂, and prostaglandin D₂.

Chemotherapeutic drugs are the mainstay of treatment on mid-advanced tumors. In recent years, more and more studies have shown that chemotherapeutic drugs also have immunomodulatory effects. Some chemotherapeutic drugs can enhance anti-tumor immunity by inducing tumor cell immunogenic cell death or performing "immunogenic modulation". In addition, chemotherapeutic drugs can also act on immune cells and even the intestinal flora. A number of clinical trials of chemotherapy combined with immune checkpoint inhibitors are currently underway. This article focuses on the immunomodulatory effect of chemotherapeutic drugs, as well as the potential of chemotherapy combined with ICI on cancer, to provide guidance for the clinical application of chemotherapeutic drugs.

Objective To revise the qualitative and quantitative determination methods of Xuanxi Rongjin powder. Methods TLC was used to qualitatively identify Chuanxiong and Chuanshanlong. The content of cinnamaldehyde in the preparation was determined by HPLC with KR100-5C₁₈ column (250 mm×4.6 mm, 5μm). The mobile phase was acetonitrile-water (35:65) and the detection wavelength was 290 nm. Results TLC can qualitatively identify Chuanxiong and Chuanshanlong. Cinnamaldehyde has a good linear relationship in the range of 0.0489~0.3260 µg/ml (r=1.00), The average recovery was 95.71% (RSD=1.78%). Conclusion The method has high sensitivity, good specificity, simple operation and good reproducibility.

A case of metachronous bilateral renal pelvic carcinoma was reported. A 55-year-old women underwent left nephroureterectomy for the left renal pelvis cancer in 2011, then she was diagnosed with right renal pelvis carcinoma because of intermittent hematuria in 2014.A transurethral ureteroscopic holmium laser resection of the right renal pelvic tumor, partial right pelvis resection and nephrostomy, instillation with hydroxycamptothecin were taken sequentially to delay the dialysis for 53 months. In 2018, the patient underwent right nephroureterectomy because of recurrence of right renal pelvic carcinoma. The patient was followed up for 17 months postoperatively and there was no recurrence. In this case, patient's renal function was protected by the premise tumor control through a variety of minimally invasive and pharmaceutical therapy, which can provide a reference for the kidney-preserving treatment of high-grade renal pelvis cancer.

Objective To establish simple screening models for nonalcoholic fatty liver disease (NAFLD) in the adult Blang population. Methods Based on the survey data of metabolic diseases in the Blang people aged 18 years or above in 2017, 2993 respondents were stratified by sex and age (at an interval of 5 years) and then randomly divided into modeling group with 1497 respondents and validation group with 1496 respondents. Related information was collected, including demographic data, smoking, drinking, family history of diseases and personal medical history, body height, body weight, waist circumference, and blood pressure, and related markers were measured, including fasting plasma glucose, 2-hour postprandial plasma glucose or blood glucose at 2 hours after glucose loading, triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase. The chi-square test was used for comparison of categorical data between two groups. Logistic regression analysis was used to establish the screening model. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value were used to evaluate the screening performance of established models versus existing models in the study population, and the DeLong method was used for comparison of AUC. Results Three screening models for NAFLD were established based on physical and biochemical measurements, i.e., simple noninvasive model 1 (age, body mass index, and waist circumference), noninvasive model 2 with the addition of blood pressure, and model 3 with the combination of hematological parameters (diabetes and ALT/AST). In the modeling group, the three models had an AUC of 0.881 (95% confidence interval [ CI ]: 0.864-0.897), 0.892 (95% CI : 0.875-0.907), and 0.894 (95% CI : 0.877-0.909), respectively, and there was a significant difference between model 1 and models 2/3 ( P =0.004 0 and P < 0.001); in the validation group, the three models had an AUC of 0.891 (95% CI : 0.874-0.906), 0.892 (95% CI : 0.875-0.907), and 0.893 (95% CI : 0.876-0.908), respectively, and there was no significant difference between the three groups ( P > 0.05). Based on the overall consideration of screening performance, invasiveness, and cost, the simple noninvasive model 1 was considered the optimal screening model for NAFLD in this population. Model 1 had the highest Youden index at the cut-off value of 5 points, and when the score of ≥5 points was selected as the criteria for NAFLD, the model had a sensitivity of 86.5%, a specificity of 79.7%, a positive predictive value of 50.3%, and a negative predictive value of 96.1% in the modeling group and a sensitivity of 85.6%, a specificity of 80.6%, a positive predictive value of 51.7%, and a negative predictive value of 95.8% in the validation group. Conclusion The NAFLD screening models established for the adult Blang population based on age and obesity indicators have relatively higher sensitivity, specificity, and negative predictive value, and this tool is of important practical significance for the intervention of NAFLD and its closely related metabolic diseases in this population.

Objective To summarize the preliminary experience of extraperitoneal laparoscopic radical prostatectomy (C.R.P.C.four-step) for localized prostate cancer and the outcomes based on early follow-up.Methods A total of 102 prostate cancer patients were screened by prostate specific antigen (PSA) and diagnosed by prostate magnetic resonance imaging and prostatic puncture biopsy with cT1c-cT3b,with average age of (67 ±5) years old,average preoperative total PSA value of (45.32 ± 18.33) ng/ml,and average prostate volume was (42 ± 12)cm3.All these patients underwent extraperitoneal laparoscopic radical prostatectomy by the four-step technique,abbreviating as C.R.P.C.[C:control DVC (dorsal deep venous complex).R:recognize three anatomical layers (prostate and bladder junction,seminal vesicle,and Denonvilliers' fascia surface).P:preserve urethral sphincter and bladder neck.C:continuous anastomosis between urethra and bladder neck (4 key needles at 3,5,7 and 9 o'clock)].The operative time,estimated blood loss,length of hospital stay and postoperative complications were recorded,and the postoperative PSA was followed up.Results All the 102 cases were successfully treated by iaparoscopic radical prostatectomy.The operative time was from 55 to 156 min (mean 92 min),and the estimated blood loss was from 55 to 185 ml (mean 105 ml).There was no case converted of open surgery,only one case received blood transfusion for postoperative hemorrhage (0.98％),and positive surgical margin was found in 15 case (14.70％) by pathological examination.Postoperative urinary extravasation within one week occurred in 2 (1.96％) cases,and resolved after tensioning the catheter and prolonging the indwelling time.During the follow-up period of 12 to 45 months,2 cases were incontinent (grade I-II),and the other cases(98.04％) had no incontinence or dysuria.However,11 cases (10.78％) developed to biochemical recurrence within 6 months after the operation.Conclusions The C.R.P.C.four-step technique of lparoscopic radical prostatectomy is easily to be grasped and performed by the greenhand urologists,and was efficient and safe.