Objective:To evaluate the advantages and short-term clinical effects of totally robotic Nissen 360° fundoplication compared with laparoscopic surgery.Methods:A retrospective analysis was conducted on data of 110 patients undergoing Nissen 360° fundoplication at the Second Department of General Surgery, Yan'an Hospital Affiliated to Kunming Medical University from Aug 2023 to Aug 2024. Among them, 50 cases underwent totally robotic fundoplication, and 60 cases underwent laparoscopic fundoplication. By comparing and analyzing the fatigue level of the primary surgeon during the operations, postoperative incisional pain in patients, swallowing function recovery and the time to resume a normal solid-food diet within 3 months post-surgery, the advantages of totally robotic surgery were evaluated. Additionally, by examining the postoperative recovery of reflux symptoms, postoperative patient comfort, and satisfaction levels in both groups, the short-term clinical outcomes of totally robotic surgery were assessed.Results:Both groups of patients successfully completed the surgeries without any intraoperative or postoperative complications occurring. The fatigue score of the primary surgeon in the totally robotic group was significantly better than that in the laparoscopic group[ (2.34±1.38) vs. (2.89±1.51), t=1.385, P<0.01]. The time taken to resume a normal solid-food diet postoperatively in the totally robotic group was significantly shorter than that in the laparoscopic group[ (27.90±6.77) d vs. (40.78±13.60) d, t =5.765, P<0.01]. Moreover, the postoperative pain comfort level was better in the robotic group than in the laparoscopic group [(1.65±0.72) points vs. (2.23±0.59) points, t=3.742, P<0.01]. Within 12 months postoperatively, the GERD-Q scores in the totally robotic group decreased significantly, and reflux symptoms disappeared, comparable to that in the laparoscopic group. Conclusions:The totally robotic Nissen 360° fundoplication leads to lower fatigue levels for the surgeon. Patients experience significant advantages in terms of postoperative pain perception and dietary recovery. Additionally, it demonstrates excellent postoperative anti-reflux efficacy, high patient comfort, and the surgery is safe and reliable.

Objective:To evaluate the advantages and short-term clinical effects of totally robotic Nissen 360° fundoplication compared with laparoscopic surgery.Methods:A retrospective analysis was conducted on data of 110 patients undergoing Nissen 360° fundoplication at the Second Department of General Surgery, Yan'an Hospital Affiliated to Kunming Medical University from Aug 2023 to Aug 2024. Among them, 50 cases underwent totally robotic fundoplication, and 60 cases underwent laparoscopic fundoplication. By comparing and analyzing the fatigue level of the primary surgeon during the operations, postoperative incisional pain in patients, swallowing function recovery and the time to resume a normal solid-food diet within 3 months post-surgery, the advantages of totally robotic surgery were evaluated. Additionally, by examining the postoperative recovery of reflux symptoms, postoperative patient comfort, and satisfaction levels in both groups, the short-term clinical outcomes of totally robotic surgery were assessed.Results:Both groups of patients successfully completed the surgeries without any intraoperative or postoperative complications occurring. The fatigue score of the primary surgeon in the totally robotic group was significantly better than that in the laparoscopic group[ (2.34±1.38) vs. (2.89±1.51), t=1.385, P<0.01]. The time taken to resume a normal solid-food diet postoperatively in the totally robotic group was significantly shorter than that in the laparoscopic group[ (27.90±6.77) d vs. (40.78±13.60) d, t =5.765, P<0.01]. Moreover, the postoperative pain comfort level was better in the robotic group than in the laparoscopic group [(1.65±0.72) points vs. (2.23±0.59) points, t=3.742, P<0.01]. Within 12 months postoperatively, the GERD-Q scores in the totally robotic group decreased significantly, and reflux symptoms disappeared, comparable to that in the laparoscopic group. Conclusions:The totally robotic Nissen 360° fundoplication leads to lower fatigue levels for the surgeon. Patients experience significant advantages in terms of postoperative pain perception and dietary recovery. Additionally, it demonstrates excellent postoperative anti-reflux efficacy, high patient comfort, and the surgery is safe and reliable.

ObjectiveTo investigate the mechanism of Renshen Guben oral liquids（RGOL） in treatment of mice with renal fibrosis based on metabolomics and network pharmacology. MethodC57BL/6 mice were randomly divided into control group， model group and RGOL group， 12 mice in each group. Except for the control group， mice in the other groups were induced into unilateral ureteral obstruction（UUO） model by UUO. After preparation of the model， an aqueous solution of 4.2 g·kg^-1 extract powder was administered by gavage to RGOL group for 14 d， and an equal amount of distilled water was administered by gavage to the control and model groups. After the last administration on the 14^th day， urine was collected and detected by ultra-high performance liquid chromatography-triple quadrupole tandem mass spectrometry（UPLC-QQQ-MS/MS） with 0.1% formic acid aqueous solution as mobile phase A， and acetonitrile-isopropanol（70∶30） as mobile phase B for gradient elution（0-1 min， 5%B； 1-5 min， 5%-30%B； 5-9 min， 30%-50%B； 9-11 min， 50%-78%B； 11-13.5 min， 78%-95%B； 13.5-14 min， 95%-100%B； 14-16 min， 100%B； 16-16.1 min， 100%-5%B； 16.1-18 min， 5%B）， column temperature of 40 ℃， flow rate of 0.4 mL·min^-1， electrospray ionization（ESI）， collection range of m/z 50-900. Through network pharmacology， the targets of components in RGOL and the targets of renal fibrosis were analyzed interactively， and the key components and key targets were screened by network topology analysis， and DAVID platform was used to predict the signaling pathways of RGOL for the treatment of renal fibrosis. ResultA total of 7 differential metabolites involving 8 metabolic pathways were identified in RGOL for the treatment of renal fibrosis. The network pharmacology revealed that 36 key components in RGOL were related to 7 differential metabolites， mainly ginsenosides， notoginsenosides and nucleotides. Based on the herbs-components-targets-pathways network， a total of 23 key targets related to the treatment of renal fibrosis by RGOL were highlighted， which together with the differential metabolites were involved in linoleic acid metabolism， arginine biosynthesis， tricarboxylic acid cycle（TCA）， arginine and proline metabolism and other pathways. ConclusionBased on metabolomics and network pharmacology， this study preliminarily identified 7 differential metabolites， 36 potential pharmacodynamic components and 23 key targets and 4 key pathways in RGOL for the treatment of renal fibrosis， providing an experimental basis for the clinical application and mechanism study of this preparation.

Objective:To investigate the relationship between serum free triiodothyronine (FT 3) and the severity and prognosis of elderly patients with coronavirus disease 2019 (COVID-19). Methods:Clinical data of the elderly patients aged≥65 years old with COVID-19 who were admitted to the Ninth People′s Hospital of Wuxi from December 27, 2022 to January 18, 2023 were collected. The laboratory examinations of the non-severe and the severe/critical groups were compared. Patients were divided into group T1 (FT 3<2.51 pmol/L), group T2 (FT 3=2.51 to 2.95 pmol/L, ), and group T3 (FT 3>2.95 pmol/L) according to the FT 3 level. Independent sample t test was used for comparison between groups. Logistic regression analysis was performed to evaluate the risk factors for severe/critical disease, and to analyze the risk of severe/critical COVID-19 in elderly patients with different FT 3 levels. The receiver operator characteristic (ROC) curve was drawn to analyze the predictive value of FT 3 on the occurrence of severe/critical disease in patients. Kaplan-Meier survival curve and log-rank test were used to analyze the 30-day survival rate of elderly COVID-19 patients. Results:Among the 190 patients, the FT 3 level in the severe/critical group was (2.54±0.30) pmol/L, which was significantly lower than that in the non-severe group ((2.91±0.69) pmol/L), and the difference was statistically significant ( t=-3.42, P=0.001). Elevated serum FT 3 level was a protective factor for severe/critical disease in elderly COVID-19 patients (odds ratio ( OR)=0.139, 95% confidence interval ( CI) 0.034 to 0.577, P=0.007). There were 66 patients in the T1 group, 61 in the T2 group and 63 in the T3 group, respectively. After adjusted for sex, age, history of lung diseases, history of cardiac diseases, history of hypertension, history of diabetes mellitus, history of cerebral infarction, white blood cell count, lactate dehydrogenase, D-dimer, free thyroxine and thyrotropin, the risk of developing severe/critical disease in group T1 and group T2 were 10.982 folds and 3.695 folds of that in group T3, respectively (both P<0.05). The area under ROC curve of FT 3 of predicting severe/critical COVID-19 in the elderly patients was 0.731. The sensitivity and specificity were 0.733 and 0.659, respectively. The cut-off value was 2.53 pmol/L. The 30-day survival rate in patients with FT 3<2.53 pmol/L was significantly lower than that in patients with FT 3≥2.53 pmol/L ( χ2=13.49, P<0.001). Conclusions:The elevated level of FT 3 is a protective factor for progression to severe/critical disease in elderly patients with COVID-19. The evaluation of serum FT 3 could predict the severity and prognosis of elderly COVID-19 patients.

Objective To investigation the serum sex hormone levels of 1 380 menstrual disorder women in Qingshan district of Wuhan city .Methods Applying Electrochemiluminescence immunoassay (ECLIA ) to detection the density of progesterone (PROG) ,testosterone(TEST) ,prolactin(PRL) ,estradiol(E2) ,luteinizing hormone(LH) and follicle‐stimulating hormone(FSH) in serum .Results 199 cases of PROG were abnormal ,which accounted for 14 .42% ;128 cases of TEST were abnormal ,which accoun‐ted for 9 .28% ;323 cases of PROL were abnormal ,which accounted for 23 .41% ;334 cases of E2 were abnormal ,which accounted for 24 .20% ;568 cases of LH were abnormal ,which accounted for 41 .16% ;553 cases of FSH were abnormal ,which accounted for 40 .07% .Conclusion In the menstrual disorder women in Qingshan district of Wuhan city ,LH and FSH anomaly is the highest proportion ,ovarian dysfunction may be the main reason for female menstrual disorder .

ObjectiveTo investigate the clinical characteristics in ABO-incompatible allogeneic peripheral blood stem cell transplantation(allo-PBSCT).Methods137 patients'clinical courses who accepted allo-PBSCT were retrospectively reviewed. Sixty-five cases of them were ABO-incompatible allo-PBSCT patients,including 32 ABO major mismatched cases,23 ABO minor mismatched cases and 10 ABO major and minor mismatched cases.Seventy-two ABO-identical cases were taken as control group.ResultsCompared with ABO-idential cases,the time of erythrocyte recovery after allo-PBSCT in ABO major and minor mismatched group was delayed [(73.2+10.3) d vs (97.5+10.4) d] (P ＜0.05).In ABO-incompatible group, the time of blood type switching in different ABO-incompatible types were found no significant difference (P ＞0.05) [ABO major mismatched:(45.7±17.3) d,ABO minor mismatched:(41.2+16.1) d and ABO major and minor mismatched:(48.4±20.9) d (P ＞ 0.05)].There were 8 cases who have a delayed time of blood type changing, including 6 cases demonstrated recipient-derived anti-A antibody. ConclusionABO-incompatible has no negative effect on allo-PBSCT.The time of erythrocyte reconstitution was delayed in ABO major and minor mismatched group.A delayed time of blood type switching tends to occur in ABO minor incompatible cases and patients who have anti-A antibody initially.

OBJECTIVEUsing Apocynum venetum as a model drug to prepare pulsed-release tablets based on diffusion, swelling, osmotic pressure mechanism and to evaluate the release characteristics.

METHODThe pulsatile release tablets were prepared by film coating methods using HPMC E5 and Eudragit The effect of formulation on pulsatile release of A. venetum was investigated.

RESULTThe pulsed-release tablet was prepared by a swelling layer coating which contains HPMC E5 and a controlled-release membrane containning Eudragit. The delayed release time of the tablets was (5.0 +/- 0.5) h.

CONCLUSIONThe pulsatile release characteristics of A. venetum pulsatile release tablets were confirmed in vitro.

Apocynum ; chemistry ; Delayed-Action Preparations ; chemistry ; Diffusion ; Drug Compounding ; methods ; Drugs, Chinese Herbal ; chemistry ; In Vitro Techniques ; Lactose ; analogs & derivatives ; analysis ; Methylcellulose ; analogs & derivatives ; analysis ; Osmotic Pressure ; Plant Leaves ; chemistry ; Polymethacrylic Acids ; analysis ; Solubility ; Tablets ; chemistry ; Time Factors

OBJECTIVE To study the status of the distribution and drug resistance of Enterococcus in hospital,in order to further provide the effective reference for rational use of antibacterial and the prevention of Enterococcus in clinical therapy. METHODS The drug sensitivity and resistance of 201 strains of Enterococcus were determined by MicroScan WalkAway40 automatic microorganism system. RESULTS The highest incidence rate of Enterococcus was E. faecium (48.8%),the second was E. faecalis (37.3%),and the others were E. gallinarum (13.9%). The drug resistance of E. faecium was much higher than that of E. faecalis. CONCLUSIONS The most of Enterococcus infection is due to E. faecium,and there is a lot of difference for drug resistance in the strains of Enterococcus. It is necessary to rationally use antibacterials on the basis of the drug resistance,infection sites and grade of infection.

The important sign of scaling graduate culture quality is the quality of doctor degree papers.By strengthening the doctor degree management and carrying out the system of outside university experts' double blind judge,the doctor degree papers can be appraised scientifically,reasonably,impersonally and justly so as to achieve the aim of promoting the quality of doctor degree thesis.

The clinic ability training is the important tache of cultivating postgraduates with the degree of clinical medicine and the clinic ability training's quality control is the important issue.This paper analyzed the existent problems in cultivation at present and expatiated the steps and countermeasure we ought to adopt in light of the actual condition of our university.