This study used the natural flavonoid compound silybin as the parent compound and synthesized 16 silybin derivatives through oxidative dehydrogenation, alkylation, selective demethylation, and acylation. The structures of these derivatives were confirmed by 1H NMR, 13C NMR, and MS. All derivatives were found to be new compounds never reported in previous literature. Using gastric cancer cell line SGC-7901 and human glioblastoma cell line LN-229, the in vitro anti-tumor activity of the novel silybin derivative was determined through MTT assay with lapatinib as the positive control. The experimental results indicate that the synthesized novel silybin derivatives have a certain degree of anti-proliferative effect on two types of cancer cells, with compounds I2 and I14 showing strong anti-proliferative activity against LN-229 and SGC-7901 cells.

Objective To investigate the influencing factors and predictive efficacy of joint function recovery in patients with tibial plateau fracture with intercondylar spine.Methods Fifty-eight patients with tibial plateau fracture with intercondylar spine admitted to the hospital from May 2020 to July 2022 were selected,all of whom were treated by surgery.The patients were followed up for 12 months after surgery,at the last follow-up,the patients were divided into two groups:poor prognosis group and good prognosis group according to Hospital for Special Surgery(HSS)score,and the clinical data of the two groups were compared.R software was used to build a nomogram prediction model based on the risk factors affecting the poor prognosis of postoperative joint function.Goodness of fit test,receiver operating characteristic(ROC)curve to assess risk nomogram model calibration and differentiation.Results All 58 patients were followed up for 12 months after operation.The HSS score at the last follow-up was 40-95 points,of which 19 were＜59 points.The results of univariate analysis showed that BMI,osteoporosis,preoperative ASA grade,skin and soft tissue injury,intercondylar spine fracture block free,and postoperative functional training may be correlated with poor prognosis of postoperative joint function(P＜0.05).Multivariate logistic regression analysis showed that BMI ≥23 kg/m2,osteoporosis,preoperative ASA grade Ⅲ to Ⅳ,skin and soft tissue injury,intercondylar spine fracture mass free and non-adherence to postoperative functional training were independent risk factors for poor prognosis of postoperative joint function(P＜0.05),there was no interaction among the risk factors(deviation=1.02,Pearson x2=0.98,R2=0.34,P＞0.05).A nomogram model was constructed based on BMI,osteoporosis,preoperative ASA grading,skin and soft tissue injury,intercondylar spine fracture block free,and postoperative functional training.Calibration results showed that the measured values were basically consistent with the predicted values.The results of the Bootstrap internal validation method showed that the sensitivity,specificity,and area under the ROC curve of this nomogram model for predicting poor postoperative joint function recovery in patients with tibial plateau fractures with intercondylar spinous fractures were 86.50％,72.40％,and 0.885,respectively.Conclusion BMI ≥ 23 kg/m2,osteoporosis,preoperative ASA grade,skin and soft tissue injury,intercondylar spine fracture fragment free,and non-adherence to postoperative functional training are risk factors for poor prognosis of postoperative joint function in patients with tibial plateau fracture with intercondylar spine fracture.The nomogram model constructed based on this has good accuracy and discrimination.

Objective To investigate the influencing factors and predictive efficacy of joint function recovery in patients with tibial plateau fracture with intercondylar spine.Methods Fifty-eight patients with tibial plateau fracture with intercondylar spine admitted to the hospital from May 2020 to July 2022 were selected,all of whom were treated by surgery.The patients were followed up for 12 months after surgery,at the last follow-up,the patients were divided into two groups:poor prognosis group and good prognosis group according to Hospital for Special Surgery(HSS)score,and the clinical data of the two groups were compared.R software was used to build a nomogram prediction model based on the risk factors affecting the poor prognosis of postoperative joint function.Goodness of fit test,receiver operating characteristic(ROC)curve to assess risk nomogram model calibration and differentiation.Results All 58 patients were followed up for 12 months after operation.The HSS score at the last follow-up was 40-95 points,of which 19 were＜59 points.The results of univariate analysis showed that BMI,osteoporosis,preoperative ASA grade,skin and soft tissue injury,intercondylar spine fracture block free,and postoperative functional training may be correlated with poor prognosis of postoperative joint function(P＜0.05).Multivariate logistic regression analysis showed that BMI ≥23 kg/m2,osteoporosis,preoperative ASA grade Ⅲ to Ⅳ,skin and soft tissue injury,intercondylar spine fracture mass free and non-adherence to postoperative functional training were independent risk factors for poor prognosis of postoperative joint function(P＜0.05),there was no interaction among the risk factors(deviation=1.02,Pearson x2=0.98,R2=0.34,P＞0.05).A nomogram model was constructed based on BMI,osteoporosis,preoperative ASA grading,skin and soft tissue injury,intercondylar spine fracture block free,and postoperative functional training.Calibration results showed that the measured values were basically consistent with the predicted values.The results of the Bootstrap internal validation method showed that the sensitivity,specificity,and area under the ROC curve of this nomogram model for predicting poor postoperative joint function recovery in patients with tibial plateau fractures with intercondylar spinous fractures were 86.50％,72.40％,and 0.885,respectively.Conclusion BMI ≥ 23 kg/m2,osteoporosis,preoperative ASA grade,skin and soft tissue injury,intercondylar spine fracture fragment free,and non-adherence to postoperative functional training are risk factors for poor prognosis of postoperative joint function in patients with tibial plateau fracture with intercondylar spine fracture.The nomogram model constructed based on this has good accuracy and discrimination.

Objective To investigate the relationship between the morphology and elasticity of the levator ani muscle(LAM)and stress urinary incontinence(SUI),and to develop a multimodal diagnostic model for SUI based on LAM morphology and elasticity parameters,while evaluating the diagnostic performance of this model.Methods From September 2020 to September 2022,147 female patients with SUI from the Affiliated Hospital of North China University of Science and Technology were enrolled as the SUI group(case group),while 144 women without SUI during the same period were selected as the non-SUI group(control group).Transperineal ultrasonography was conducted to measure the anteroposterior diameter(LH-A1)and transverse diameter(LH-D1)of the levator hiatus at rest,the resting area of the levator hiatus(LA1),as well as the anteroposterior diameter(LH-A2),transverse diameter(LH-D2),and area(LA2)of the levator hiatus during the maximum Valsalva maneuver.Addi-tionally,ultrasonography was used to observe LAM injury(LA-MI)during pelvic muscle contraction.Shear wave elastography(SWE)was also performed transperineally to record the elastic modulus values of the puborectalis muscle at rest(E1)and during pelvic muscle contraction(E3).The differences in ultrasound parameters between the two groups were compared,and a logistic regression model was constructed for multivariate analysis to establish a diagnostic model for SUI.The goodness of fit of the logistic regression model was assessed using the Hosmer-Lemeshow test.The diagnostic performance of individual indicators and the diagnostic model for SUI was evaluated using the receiver operating characteristic(ROC)curve.Finally,the clinical utility of the model was assessed using decision curve analysis.Results There were statistically significant differences in age,BMI,LH-A1,LH-D1,LA1,LH-A2,LH-D2,LA2,LA-MI,E1,and E3 between the two groups(P<0.05).Multivariate logistic regression analysis revealed that age,BMI,LH-A1,LA2,LA-MI,E1,and E3 were significantly associated with SUI(P<0.05).Based on these findings,a diagnostic model for SUI was established:PRESUI=0.261×age+0.904×BMI-4.300×LH-A1+1.166×LA2-2.815×LA-MI+0.587×E1-0.631×E3-1.258.The model demon-strated excellent goodness-of-fit(P=0.983).The ROC curve analysis indicated that age,BMI,LH-A1,LA2,LA-MI,E1,and E3 all exhibited diagnostic efficacy for SUI(AUC>0.500,P<0.05).Notably,the AUC of the constructed diagnostic model for SUI was 0.996(95%CI:0.992～1.000),suggesting that the diagnostic accuracy of the model surpassed that of individual indicators.When the cut-off value of the diagnostic model was set at 0.437,the sensitivity reached 98.0%,and the specificity was 97.2%.Furthermore,the decision curve analysis demon-strated that the diagnostic model provided substantial net clinical benefit within the threshold probability range of 0.1 to 1.0.Conclusions The morphology and elasticity of the LAM are significantly altered in women with SUI.The SWE technique demonstrates potential application value for quantitatively assessing the elasticity of the LAM.Furthermore,the diagnostic model constructed based on age,BMI,LH-A1,LA2,LA-MI,E1,and E3 exhibits high clinical application value.

Objective To investigate the relationship between the morphology and elasticity of the levator ani muscle(LAM)and stress urinary incontinence(SUI),and to develop a multimodal diagnostic model for SUI based on LAM morphology and elasticity parameters,while evaluating the diagnostic performance of this model.Methods From September 2020 to September 2022,147 female patients with SUI from the Affiliated Hospital of North China University of Science and Technology were enrolled as the SUI group(case group),while 144 women without SUI during the same period were selected as the non-SUI group(control group).Transperineal ultrasonography was conducted to measure the anteroposterior diameter(LH-A1)and transverse diameter(LH-D1)of the levator hiatus at rest,the resting area of the levator hiatus(LA1),as well as the anteroposterior diameter(LH-A2),transverse diameter(LH-D2),and area(LA2)of the levator hiatus during the maximum Valsalva maneuver.Addi-tionally,ultrasonography was used to observe LAM injury(LA-MI)during pelvic muscle contraction.Shear wave elastography(SWE)was also performed transperineally to record the elastic modulus values of the puborectalis muscle at rest(E1)and during pelvic muscle contraction(E3).The differences in ultrasound parameters between the two groups were compared,and a logistic regression model was constructed for multivariate analysis to establish a diagnostic model for SUI.The goodness of fit of the logistic regression model was assessed using the Hosmer-Lemeshow test.The diagnostic performance of individual indicators and the diagnostic model for SUI was evaluated using the receiver operating characteristic(ROC)curve.Finally,the clinical utility of the model was assessed using decision curve analysis.Results There were statistically significant differences in age,BMI,LH-A1,LH-D1,LA1,LH-A2,LH-D2,LA2,LA-MI,E1,and E3 between the two groups(P<0.05).Multivariate logistic regression analysis revealed that age,BMI,LH-A1,LA2,LA-MI,E1,and E3 were significantly associated with SUI(P<0.05).Based on these findings,a diagnostic model for SUI was established:PRESUI=0.261×age+0.904×BMI-4.300×LH-A1+1.166×LA2-2.815×LA-MI+0.587×E1-0.631×E3-1.258.The model demon-strated excellent goodness-of-fit(P=0.983).The ROC curve analysis indicated that age,BMI,LH-A1,LA2,LA-MI,E1,and E3 all exhibited diagnostic efficacy for SUI(AUC>0.500,P<0.05).Notably,the AUC of the constructed diagnostic model for SUI was 0.996(95%CI:0.992～1.000),suggesting that the diagnostic accuracy of the model surpassed that of individual indicators.When the cut-off value of the diagnostic model was set at 0.437,the sensitivity reached 98.0%,and the specificity was 97.2%.Furthermore,the decision curve analysis demon-strated that the diagnostic model provided substantial net clinical benefit within the threshold probability range of 0.1 to 1.0.Conclusions The morphology and elasticity of the LAM are significantly altered in women with SUI.The SWE technique demonstrates potential application value for quantitatively assessing the elasticity of the LAM.Furthermore,the diagnostic model constructed based on age,BMI,LH-A1,LA2,LA-MI,E1,and E3 exhibits high clinical application value.

Objective:To evaluate the safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy.Methods:This prospective, multi-center, single-arm study was initiated by the Affiliated Cancer Hospital of Zhengzhou University in June 2021 (CRAFT Study, NCT05282563). Participating institutions included Nanyang Central Hospital, Zhumadian Central Hospital, Luoyang Central Hospital, First Affiliated Hospital of Henan Polytechnic University, First Affiliated Hospital of Henan University, Luohe Central Hospital, the People's Hospital of Hebi, First People's Hospital of Shangqiu, Anyang Tumor Hospital, First People's Hospital of Pingdingshan, and Zhengzhou Central Hospital Affiliated to Zhengzhou University. Inclusion criteria were as follows: (1) gastric adenocarcinoma confirmed by preoperative gastroscopy;(2) preoperative imaging assessment indicated that R0 resection was feasible; (3) preoperative assessment showed no contraindications to surgery;(4) esophagojejunostomy planned during the procedure; (5) patients volunteered to participate in this study and gave their written informed consent; (6) ECOG score 0–1; and (7) ASA score I–III. Exclusion criteria were as follows: (1) history of upper abdominal surgery (except laparoscopic cholecystectomy);(2) history of gastric surgery (except endoscopic submucosal dissection and endoscopic mucosal resection); (3) pregnancy or lactation;(4) emergency surgery for gastric cancer-related complications (perforation, hemorrhage, obstruction); (5) other malignant tumors within 5 years or coexisting malignant tumors;(6) arterial embolism within 6 months, such as angina pectoris, myocardial infarction, and cerebrovascular accident; and (7) comorbidities or mental health abnormalities that could affect patients' participation in the study. Patients were eliminated from the study if: (1) radical gastrectomy could not be completed; (2) end-to-side esophagojejunal anastomosis was not performed during the procedure; or (3) esophagojejunal anastomosis reinforcement was not possible. Double and a half layered esophagojejunal anastomosis was performed as follows: (1) Open surgery: the full thickness of the anastomosis is continuously sutured, followed by embedding the seromuscular layer with barbed or 3-0 absorbable sutures. The anastomosis is sutured with an average of six to eight stitches. (2) Laparoscopic surgery: the anastomosis is strengthened by counterclockwise full-layer sutures. Once the anastomosis has been sutured to the right posterior aspect of the anastomosis, the jejunum stump is pulled to the right and the anastomosis turned over to continue to complete reinforcement of the posterior wall. The suture interval is approximately 5 mm. After completing the full-thickness suture, the anastomosis is embedded in the seromuscular layer. Relevant data of patients who had undergone radical gastrectomy in the above 12 centers from June 2021 were collected and analyzed. The primary outcome was safety (e.g., postoperative complications, and treatment). Other studied variables included details of surgery (e.g., surgery time, intraoperative bleeding), postoperative recovery (postoperative time to passing flatus and oral intake, length of hospital stay), and follow-up conditions (quality of life as assessed by Visick scores).Result:[1] From June 2021 to September 2022,457 patients were enrolled, including 355 men and 102 women of median age 60.8±10.1 years and BMI 23.7±3.2 kg/m2. The tumors were located in the upper stomach in 294 patients, mid stomach in 139; and lower stomach in 24. The surgical procedures comprised 48 proximal gastrectomies and 409 total gastrectomies. Neoadjuvant chemotherapy was administered to 85 patients. Other organs were resected in 85 patients. The maximum tumor diameter was 4.3±2.2 cm, number of excised lymph nodes 28.3±15.2, and number of positive lymph nodes five (range one to four. As to pathological stage,83 patients had Stage I disease, 128 Stage II, 237 Stage III, and nine Stage IV. [2] The studied surgery-related variables were as follows: The operation was successfully completed in all patients, 352 via a transabdominal approach, 25 via a transhiatus approach, and 80 via a transthoracoabdominal approach. The whole procedure was performed laparoscopically in 53 patients (11.6%), 189 (41.4%) underwent laparoscopic-assisted surgery, and 215 (47.0%) underwent open surgery. The median intraoperative blood loss was 200 (range, 10–1 350) mL, and the operating time 215.6±66.7 minutes. The anastomotic reinforcement time was 2 (7.3±3.9) minutes for laparoscopic-assisted surgery, 17.6±1.7 minutes for total laparoscopy, and 6.0±1.2 minutes for open surgery. [3] The studied postoperative variables were as follows: The median time to postoperative passage of flatus was 3.1±1.1 days and the postoperative gastrointestinal angiography time 6 (range, 4–13) days. The median time to postoperative oral intake was 7 (range, 2–14) days, and the postoperative hospitalization time 15.8±6.7 days. [4] The safety-related variables were as follows: In total, there were 184 (40.3%) postoperative complications. These comprised esophagojejunal anastomosis complications in 10 patients (2.2%), four (0.9%) being anastomotic leakage (including two cases of subclinical leakage and two of clinical leakage; all resolved with conservative treatment); and six patients (1.3%) with anastomotic stenosis (two who underwent endoscopic balloon dilation 21 and 46 days after surgery, the others improved after a change in diet). There was no anastomotic bleeding. Non-anastomotic complications occurred in 174 patients (38.1%). All patients attended for follow-up at least once, the median follow-up time being 10 (3–18) months. Visick grades were as follows: Class I, 89.1% (407/457); Class II, 7.9% (36/457); Class III, 2.6% (12/457); and Class IV 0.4% (2/457).Conclusion:Double and a half layered esophagojejunal anastomosis in radical gastrectomy is safe and feasible.

OBJECTIVE: To investigate the clinical value of analgesia and sedation under bispectral index (BIS) monitoring combined with hydraulic coupled intracranial pressure (ICP) monitoring in severe craniocerebral injury (sTBI). METHODS: (1) A prospective self-controlled parallel control study was conducted. A total of 32 patients with sTBI after craniotomy admitted to the intensive care unit (ICU) of the First People's Hospital of Huzhou from December 2020 to July 2021 were selected as the research objects. ICP was monitored by Codman monitoring system and hydraulically coupled monitoring system, and the difference and correlation between them were compared. (2) A prospective randomized controlled study was conducted. A total of 108 sTBI patients admitted to the ICU of the First People's Hospital of Huzhou from August 2021 to August 2022 were selected patients were divided into 3 groups according to the random number table method. All patients were given routine treatment after brain surgery. On this basis, the ICP values of the patients in group A (35 cases) were monitored by Codman monitoring system, the ICP values of the patients in group B (40 cases) were monitored by hydraulic coupling monitoring system, and the ICP values of the patients in group C (33 cases) were monitored combined with hydraulic coupling monitoring system, and the analgesia and sedation were guided by BIS. The ICP after treatment, cerebrospinal fluid drainage time, ICP monitoring time, ICU stay time, complications and Glasgow outcome score (GOS) at 6 months after surgery were compared among the 3 groups. In addition, patients in group B and group C were further grouped according to the waveforms. If P₁ = P₂ wave or P₂ and P₃ wave were low, they were classified as compensatory group. If the round wave or P₂ > P₁ wave was defined as decompensated group, the GOS scores of the two groups at 6 months after operation were compared. RESULTS: (1) There was no significant difference in ICP values measured by Codman monitoring system and hydraulic coupling monitoring system in the same patient (mmHg: 11.94±1.76 vs. 11.88±1.90, t = 0.150, P = 0.882; 1 mmHg≈0.133 kPa). Blan-altman analysis showed that the 95% consistency limit (95%LoA) of ICP values measured by the two methods was -4.55 to 4.68 mmHg, and all points fell within 95%LoA, indicating that the two methods had a good correlation. (2) There were no significant differences in cerebrospinal fluid drainage time, ICP monitoring time, ICU stay time, and incidence of complications such as intracranial infection, intracranial rebleeding, traumatic hydrocephalus, cerebrospinal fluid leakage, and accidental extubation among the 3 groups of sTBI patients (P > 0.05 or P > 0.017). The ICP value of group C after treatment was significantly lower than that of group A and group B (mmHg: 20.94±2.37 vs. 25.86±3.15, 26.40±3.09, all P < 0.05), the incidence of pulmonary infection (9.1% vs. 45.7%, 42.5%), seizure (3.0% vs. 31.4%, 30.0%), reoperation (3.0% vs. 31.4%, 40.0%), and poor prognosis 6 months after operation (33.3% vs. 65.7%, 65.0%) were significantly lower than those in group A and group B (all P < 0.017). According to the hydraulic coupling waveform, GOS scores of 35 patients in the compensated group were significantly higher than those of 38 patients in the decompensated group 6 months after operation (4.03±1.18 vs. 2.39±1.50, t = 5.153, P < 0.001). CONCLUSIONS The hydraulic coupled intracranial pressure monitoring system has good accuracy and consistency in measuring ICP value, and it can better display ICP waveform changes than the traditional ICP monitoring method, and has better prediction value for prognosis evaluation, which can replace Codman monitoring to accurately guide clinical work. In addition, analgesia and sedation under BIS monitoring combined with hydraulic coupled ICP monitoring can effectively reduce ICP, reduce the incidence of complications, and improve the prognosis, which has high clinical application value.
Humans ; Intracranial Pressure ; Prospective Studies ; Monitoring, Physiologic/methods* ; Craniocerebral Trauma ; Analgesia ; Cerebrospinal Fluid Leak

Objective:To evaluate the safety of double and a half layered esophagojejunal anastomosis in radical gastrectomy.Methods:This prospective, multi-center, single-arm study was initiated by the Affiliated Cancer Hospital of Zhengzhou University in June 2021 (CRAFT Study, NCT05282563). Participating institutions included Nanyang Central Hospital, Zhumadian Central Hospital, Luoyang Central Hospital, First Affiliated Hospital of Henan Polytechnic University, First Affiliated Hospital of Henan University, Luohe Central Hospital, the People's Hospital of Hebi, First People's Hospital of Shangqiu, Anyang Tumor Hospital, First People's Hospital of Pingdingshan, and Zhengzhou Central Hospital Affiliated to Zhengzhou University. Inclusion criteria were as follows: (1) gastric adenocarcinoma confirmed by preoperative gastroscopy;(2) preoperative imaging assessment indicated that R0 resection was feasible; (3) preoperative assessment showed no contraindications to surgery;(4) esophagojejunostomy planned during the procedure; (5) patients volunteered to participate in this study and gave their written informed consent; (6) ECOG score 0–1; and (7) ASA score I–III. Exclusion criteria were as follows: (1) history of upper abdominal surgery (except laparoscopic cholecystectomy);(2) history of gastric surgery (except endoscopic submucosal dissection and endoscopic mucosal resection); (3) pregnancy or lactation;(4) emergency surgery for gastric cancer-related complications (perforation, hemorrhage, obstruction); (5) other malignant tumors within 5 years or coexisting malignant tumors;(6) arterial embolism within 6 months, such as angina pectoris, myocardial infarction, and cerebrovascular accident; and (7) comorbidities or mental health abnormalities that could affect patients' participation in the study. Patients were eliminated from the study if: (1) radical gastrectomy could not be completed; (2) end-to-side esophagojejunal anastomosis was not performed during the procedure; or (3) esophagojejunal anastomosis reinforcement was not possible. Double and a half layered esophagojejunal anastomosis was performed as follows: (1) Open surgery: the full thickness of the anastomosis is continuously sutured, followed by embedding the seromuscular layer with barbed or 3-0 absorbable sutures. The anastomosis is sutured with an average of six to eight stitches. (2) Laparoscopic surgery: the anastomosis is strengthened by counterclockwise full-layer sutures. Once the anastomosis has been sutured to the right posterior aspect of the anastomosis, the jejunum stump is pulled to the right and the anastomosis turned over to continue to complete reinforcement of the posterior wall. The suture interval is approximately 5 mm. After completing the full-thickness suture, the anastomosis is embedded in the seromuscular layer. Relevant data of patients who had undergone radical gastrectomy in the above 12 centers from June 2021 were collected and analyzed. The primary outcome was safety (e.g., postoperative complications, and treatment). Other studied variables included details of surgery (e.g., surgery time, intraoperative bleeding), postoperative recovery (postoperative time to passing flatus and oral intake, length of hospital stay), and follow-up conditions (quality of life as assessed by Visick scores).Result:[1] From June 2021 to September 2022,457 patients were enrolled, including 355 men and 102 women of median age 60.8±10.1 years and BMI 23.7±3.2 kg/m2. The tumors were located in the upper stomach in 294 patients, mid stomach in 139; and lower stomach in 24. The surgical procedures comprised 48 proximal gastrectomies and 409 total gastrectomies. Neoadjuvant chemotherapy was administered to 85 patients. Other organs were resected in 85 patients. The maximum tumor diameter was 4.3±2.2 cm, number of excised lymph nodes 28.3±15.2, and number of positive lymph nodes five (range one to four. As to pathological stage,83 patients had Stage I disease, 128 Stage II, 237 Stage III, and nine Stage IV. [2] The studied surgery-related variables were as follows: The operation was successfully completed in all patients, 352 via a transabdominal approach, 25 via a transhiatus approach, and 80 via a transthoracoabdominal approach. The whole procedure was performed laparoscopically in 53 patients (11.6%), 189 (41.4%) underwent laparoscopic-assisted surgery, and 215 (47.0%) underwent open surgery. The median intraoperative blood loss was 200 (range, 10–1 350) mL, and the operating time 215.6±66.7 minutes. The anastomotic reinforcement time was 2 (7.3±3.9) minutes for laparoscopic-assisted surgery, 17.6±1.7 minutes for total laparoscopy, and 6.0±1.2 minutes for open surgery. [3] The studied postoperative variables were as follows: The median time to postoperative passage of flatus was 3.1±1.1 days and the postoperative gastrointestinal angiography time 6 (range, 4–13) days. The median time to postoperative oral intake was 7 (range, 2–14) days, and the postoperative hospitalization time 15.8±6.7 days. [4] The safety-related variables were as follows: In total, there were 184 (40.3%) postoperative complications. These comprised esophagojejunal anastomosis complications in 10 patients (2.2%), four (0.9%) being anastomotic leakage (including two cases of subclinical leakage and two of clinical leakage; all resolved with conservative treatment); and six patients (1.3%) with anastomotic stenosis (two who underwent endoscopic balloon dilation 21 and 46 days after surgery, the others improved after a change in diet). There was no anastomotic bleeding. Non-anastomotic complications occurred in 174 patients (38.1%). All patients attended for follow-up at least once, the median follow-up time being 10 (3–18) months. Visick grades were as follows: Class I, 89.1% (407/457); Class II, 7.9% (36/457); Class III, 2.6% (12/457); and Class IV 0.4% (2/457).Conclusion:Double and a half layered esophagojejunal anastomosis in radical gastrectomy is safe and feasible.

Objective:To investigate the effect of decompression of optic nerve canal for traumatic optic neuropathy (TON) via lateral supraorbital approach.Methods:A retrospective case series study was performed to analyze clinical data of 23 TON patients admitted to First People's Hospital of Huzhou from December 2013 to June 2019. There were 16 males and 7 females, aged 17-51 years [(34.3±2.2)years]. Degree of visual impairment included count fingers in 4 patients, hand motion in 4, light perception in 9 and loss of light perception in 6. Visual evoked potential examination (VEP) was performed in 15 patients before surgery. The amplitude of P100 completely disappeared in 5 patients, and the amplitude of P100 was lower than the lower limit of normal value and the latency prolonged in 10 patients. The time from injury to operation was 3 h-14 days [(3.3±0.6)days]. All patients underwent decompression of optic nerve canal via supralateral orbital approach, and dural repair was performed simultaneously in 11 patients with dural rupture. Intraoperative fractures and meningeal tears, duration of operation, blood loss, and hospitalization duration were recorded. Combined with the classical visual acuity improvement assessment method and the World Health Organization (WHO) low vision and blind grading standard, visual acuity was compared before operation, at 10 days and 3 months after operation. Glasgow Coma Scale (GCS) was used to evaluate patients' state of consciousness in the course of the disease. Glasgow Outcome Scale (GOS) was used to evaluate the prognosis. Incidence of complications was observed as well.Results:All patients were followed up for 12-16 weeks [(13.5±2.4)weeks]. Intraoperative microscopic exploration revealed that all patients had optic nerve canal fracture, 3 patients had frontal fracture with dural rupture, and 8 patients had ethmoid bone fragment with anterior skull base dural rupture. The duration of operation was 108.5-224.3 minutes [(151.8±30.2)minutes], including (32.5±8.4)minutes for craniotomy. The intraoperative blood loss was 90.5-165.3 ml [(121.3±15.5)ml]. The hospitalization was 14-26 days [(19.7±3.4)days]. The visual acuity of 13 patients (57%) improved and 5 patients (39%) relieved from blindness 10 days after operation, showing significant difference compared with the preoperation ( P<0.05). The visual acuity of 17 patients (74%) improved and 9 patients (39%) relieved from blindness at 3 months after operation. There was significant difference in visual acuity examined between 10 days and 3 months after operation ( P<0.05). Six patients were invalid, and 4 of them had no light perception before operation and the amplitude of VEP examination completely disappeared. All patients had GCS of 15 when left the hospital and GOS of 5 at 3 months after operation. One patient had cerebrospinal fluid rhinorrhea and healed after 7 days of supine position. No secondary hematoma, epilepsy or intracranial infection occurred during follow-up. Conclusion:Optic canal decompression via the lateral supraorbital approach can improve visual acuity in early stage and increase the rate of out of blindness, with low postoperative complications and satisfactory functional recovery, which is worthy of clinical application.

Objective: To investigate the expression and clinical significance of exosomal miR-1231 in plasma of pancreatic cancer (PC) patients and pancreatic cancer cells. Methods: A total of 16 patients who were diagnosed with pancreatic cancer in Hunan Cancer Hospital were collected from April 2016 to August 2017. Meanwhile, 16 healthy volunteers were recruited as the healthy control group at the same period. The plasma exosomes were extracted, and the levels of miR-1231 were detected by qRT-PCR in PC and healthy control groups. Moreover, the clinicopathological significance of exosomal miR-1231 expression was analyzed. Furthermore, the expression of exosomal miR-1231 was detected in several pancreatic cancer cells (MIA PaCa-2, PANC-1, SW1990, AsPC-1 and BxPc-3) and two normal pancreatic epithelial cells (HPDE and human primary pancreatic epithelial cell). Results: qRT-PCR results showed that the expression level of miR-1231 in plasma exosomes of pancreatic cancer patients (1.06±0.46) was significantly lower than that in healthy controls (2.30±0.99; P<0.05). The levels of exosomal miR-1231 in patients with stage Ⅰ-Ⅱ (1.515±0.531), no distant metastasis (1.236±0.461) and no lymph node metastasis (1.337±0.522) were significantly higher than those with stage Ⅲ-Ⅳ (0.848±0.224), distant metastasis (0.757±0.278) and lymph node metastasis (0.838±0.261), respectively (P<0.05 for all). In addition, there were no correlation between exosomal miR-1231 expression and age, sex, smoking history, CA19-9 levels and tumor sites (P>0.05). Furthermore, the expression level of exosomal miR-1231 in pancreatic cancer cell lines (0.142±0.135) was significantly lower than that in normal epithelial cells (1.127±0.179; P<0.05). Conclusions The downregulation of exosomal miR-1231 in plasma of pancreatic cancer patients and pancreatic cancer cells suggests that it is related to the initiation and development of PC. It may be a new diagnostic and prognostic marker for PC.