1.Exploring Mechanism of Modified Banxia Xiexintang in Ameliorating Metabolic Disorders and Reproductive Function in PCOS-IR Rats Based on Metabolomics and Transcriptomics
Donghan BAI ; Ruying TANG ; Longfei LIN ; Yuling LIU ; Dongxue ZHENG ; Qiling ZHANG ; Xinmin LIU ; Hui LI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(7):140-149
ObjectiveTo evaluate the therapeutic effects of modified Banxia Xiexintang(MBXT) on polycystic ovary syndrome with insulin resistance(PCOS-IR) rats and reveal its potential mechanisms based on the integrated analysis of transcriptomics and metabolomics. MethodsFemale SD rats were selected, and a PCOS-IR model was established by intragastric administration of letrozole combined with a high-fat diet for 21 days. The modeled rats were randomly divided into the model group, MBXT low-, medium-, and high-dose groups(6.62, 13.23, 26.46 g·kg-1), and metformin group(0.158 g·kg-1), with a normal group set up separately. After 14 days of administration, the estrous cycle was observed, ovarian morphology was examined by hematoxylin-eosin(HE) staining, and the levels of testosterone(T), estradiol(E2), follicle-stimulating hormone(FSH), and luteinizing hormone(LH) in serum were detected by enzyme-linked immunosorbent assay(ELISA). Serum metabolites and ovarian tissue gene expression were detected using ultra-performance liquid chromatography-quadrupole-electrostatic orbitrap mass spectrometry(UPLC-Q-Orbitrap-MS) and RNA-Seq technology, respectively, followed by multi-omics integrated analysis. ResultsPharmacodynamic findings revealed that all MBXT dose groups could reversed abnormal estrous cycles in PCOS-IR rats, improve polycystic ovarian lesions, and normalize dysregulated serum hormone levels(T, LH, E2, FS, P<0.05, P<0.01). Metabolomic analysis revealed that compared with the model group, MBXT reversed 278 differential metabolites such as estrone and S-formylglutathione, mainly involving pathways such as steroid hormone biosynthesis, glutathione metabolism, and lipid peroxidation regulation. Transcriptomic analysis identified 434 differentially expressed genes, and enrichment analysis revealed that MBXT significantly regulated lipid peroxidation defense systems, including glutathione metabolism, peroxisome function, and fatty acid metabolism, thereby intervening in ferroptosis processes. It also engaged in inflammation-related pathways such as the chemokine signaling pathway. Integrated analysis revealed that both metabolomics and transcriptomics co-enriched metabolic pathways associated with ferroptosis and fatty acid metabolism. And key Hub genes[such as Ras-related C3 botulinum toxin substrate 2 gene(Rac2) and Fas ligand gene(Faslg)] showed significant correlations with differential metabolites. ConclusionMBXT can effectively ameliorate reproductive dysfunction and metabolic disorders in PCOS-IR rats. Its mechanism may be related to remodeling the immune-metabolism network, particularly by regulating MHC-mediated immune responses, inhibiting local ovarian ferroptosis, and enhancing steroid hormone synthesis pathways.
2.Investigation on Mechanism of Modified Banxia Xiexintang in Improving Ovarian Dysfunction of PCOS-IR Rats by Inhibiting Ferroptosis via AMPK/FASN/GPX4 Signaling Pathway
Donghan BAI ; Ruying TANG ; Longfei LIN ; Yuling LIU ; Dongxue ZHENG ; Qiling ZHANG ; Xinmin LIU ; Hui LI
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(7):150-160
ObjectiveTo investigate the mechanism of modified Banxia Xiexintang(MBXT) in improving ovarian dysfunction in polycystic ovary syndrome with insulin resistance(PCOS-IR) rats by inhibiting ferroptosis through the adenosine monophosphate(AMP)-activated protein kinase(AMPK)/fatty acid synthase(FASN)/glutathione peroxidase 4(GPX4) signaling pathway. MethodsSeventy-six female SD rats were randomly divided into a normal group(n=13) and a modeling group(n=63). The modeling group established a PCOS-IR model by intragastric administration of letrozole combined with a high-fat diet for 21 days. After successful modeling, these rats were randomly divided into the model group, MBXT low-, medium-, and high-dose groups(6.62, 13.23, 26.46 g·kg-1), metformin group(0.158 g·kg-1), and high-dose of MBXT combined with ferroptosis inducer Erastin group(15 mg·kg-1), with 10 rats in each group. After 14 days of intervention, ovarian pathological morphology was observed by hematoxylin-eosin(HE) staining, the mitochondrial ultrastructure of granulosa cells was observed by transmission electron microscopy(TEM), ovarian reactive oxygen species(ROS) levels were detected by dihydroethidium(DHE) probe, biochemical methods were used to detect Fe2+, malondialdehyde(MDA), glutathione(GSH) and other indicators in ovarian tissues, serum sex hormone and insulin levels were measured by enzyme-linked immunosorbent assay(ELISA), and the protein expressions of AMPK, FASN, acyl-CoA synthetase long-chain family member 4(ACSL4), GPX4, and solute carrier family 7 member 11(SLC7A11) in ovarian tissues were detected by Western blot. ResultsCompared with the normal group, the model group showed polycystic changes in the ovaries, with atrophy of mitochondria in granulosa cells and increased membrane density. Serum levels of testosterone(T), luteinizing hormone(LH), and insulin were significantly increased(P<0.01). The levels of ROS, MDA, 4-hydroxynonenal(4-HNE), and Fe2+ in ovarian tissues were significantly elevated(P<0.01), while adenosine triphosphate(ATP), GSH, and reduced nicotinamide adenine dinucleotide phosphate (NADPH) levels were significantly decreased(P<0.01). The phosphorylation levels of AMPK and acetyl-CoA carboxylase (ACC), as well as the protein expressions of SLC7A11, GPX4, and ferroptosis suppressor protein 1(FSP1) were significantly downregulated(P<0.01), whereas the expressions of FASN, ACSL4, and nuclear receptor coactivator 4(NCOA4) were significantly upregulated(P<0.01). Compared with the model group, MBXT intervention at various doses improved the above pathological changes and biochemical indicators in a dose-dependent manner, with the high-dose group showing the most significant effect(P<0.01). Compared with the MBXT high-dose group, the high-dose of MBXT combined with ferroptosis inducer Erastin group restored ovarian ferroptosis characteristics in rats, with increased ROS and lipid peroxidation products, and altered expressions of key proteins(P<0.05, P<0.01). ConclusionMBXT can effectively improve ovarian function and metabolic disorders in PCOS-IR rats. Its mechanism may be related to activating the AMPK/ACC signaling pathway, downregulating FASN and ACSL4 to reduce lipid peroxidation substrates, and restoring glucose-6-phosphate dehydrogenase/phosphoglycerate dehydrogenase(G6PD/PHGDH) metabolic flux to enhance the GPX4/FSP1 antioxidant defense system, thereby inhibiting ferroptosis in ovarian granulosa cells.
3.Ultrasound-guided Microwave Ablation for Uterine Arteriovenous Fistula
Yanxia FU ; Donghan LI ; Liqin CHENG ; Liqin ZENG
Journal of Sun Yat-sen University(Medical Sciences) 2026;47(4):739-746
ObjectiveTo analyze the clinical manifestations, diagnostic approaches, treatment strategies, and prognostic outcomes of uterine arteriovenous fistula (UAVF). MethodsWe retrospectively analyzed 6 patients with confirmed UAVF admitted to the Department of Gynecology, the Eighth Affiliated Hospital of Sun Yat-sen University, between January 2010 and December 2023. We summarized the clinical data of the cohort, including age, gravidity, chief complaints, treatment regimens, and postoperative follow-up outcomes, and explored the clinical efficacy and safety of ultrasound-guided microwave ablation for UAVF in conjunction with a literature review. ResultsThe patients were aged 26-44 years, with a mean age of (34.33±6.12) years and a median age of 33.5 years. All patients were initially screened via color Doppler ultrasound and definitively diagnosed by imaging modalities including uterine arteriography, computed tomography, and magnetic resonance imaging. The median gravidity was 4(4,6), with 5 patients having a history of ≥2 pregnancies. Five patients had a history of intrauterine instrumentation, among whom 4 had undergone ≥2 procedures. Regarding clinical presentations, 3 patients presented with abnormal vaginal bleeding (2 with massive hemorrhage), 2 were asymptomatic with abnormalities detected only on imaging, and 1 reported lower abdominal pain. In terms of management, 1 patient with recurrence after uterine artery embolization (UAE) underwent ultrasound-guided microwave ablation; 1 received UAE alone; 2 patients with concomitant retained products of conception underwent hysteroscopic mechanical morcellation (1 developed massive hemorrhage 10 hours postoperatively, which was successfully controlled with uterine balloon tamponade); 1 underwent focal lesion resection; and 1 underwent total hysterectomy. All 6 patients achieved favorable therapeutic outcomes. ConclusionAbnormal vaginal bleeding is the most typical clinical manifestation of UAVF, and digital subtraction angiography of the uterine arteries is recognized as the gold standard for definitive diagnosis. Emergency UAE is indicated for patients presenting with acute massive hemorrhage and hemodynamic instability. For patients with failed UAE or post-UAE recurrence who desire uterine and fertility preservation, ultrasound-guided microwave ablation represents a safe, effective, and novel minimally invasive therapeutic option.
4.Exploring the Neuroprotective Effect of Dushu Pills Aβ25-35-induced AD Model Mice Based on Network Pharmacology
Hongyu SUN ; Zhengmin LI ; Luke ZHAI ; Boyu WANG ; Yuan LING ; Donghan ZHAO ; Juan ZHANG ; Zhenqiang ZHANG ; Zijuan ZHANG
World Science and Technology-Modernization of Traditional Chinese Medicine 2025;27(1):255-267
Objective To explore the effects of Dushu pills on cognitive ability and mitochondrial dynamics related proteins in mouse model of Alzheimer's disease(AD)based on network pharmacology.Methods The corresponding targets of Dushu pills and its related targets with AD were predicted using TCMSP database.The intersection targets of Dushu pills and AD were obtained by Venny website.The protein interaction network and drug-disease-target network were mapped using String database and Cytoscape software,respectively.GO and KEGG enrichment analysis were performed for intersection targets using David database.The mouse model of AD was established by injecting Aβ25-35 into bilateral ventricles.The learning and memory ability of the mice was detected by behavioral tests,the mitochondrial damage of neurons in the hippocampus was observed by transmission electron microscopy,and the expression of proteins related to mitochondrial dynamics was detected by Western blot.Results A total of 311 intersection targets related to drugs and diseases were screened out from the database.GO and KEGG analysis showed that the relevant targets were concentrated in mitochondria and other components,and concentrated in the pathways of ATP binding and positive regulation of MAPK activity.Compared with the normal group,the learning and memory ability of the model group was decreased(P<0.05),mitochondrial ridges appeared swelling and fracture(P<0.0001),decreased expression of MAPK,Mfn2 and OPA1 proteins in hippocampus(P<0.01),the expression of DRP1 protein increased(P<0.01).Compared with the model group,the learning and memory ability of mice in the medium and high dose groups of Dushu pills was improved(P<0.05),mitochondrial damage was significantly improved(P<0.01),increased expression of MAPK,Mfn2 and OPA1 in the hippocampus(P<0.01),DRP1 protein expression decreased(P<0.01).Conclusion Dushu pills can reduce mitochondrial damage,maintain mitochondrial homeostasis,and improve the cognitive and memory ability of AD mice.
5.Characterization of Medicinal Amber via Multispectral Analysis Combined with ICP-MS
Donghan BAI ; Zerun LI ; Xueying XIN ; Lu LUO
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):176-183
ObjectiveTo systematically investigate the identification characteristics of medicinal amber, elucidate its microscopic features, crystal structural properties, and elemental composition, and thereby provide a scientific foundation for quality control and authenticity verification. MethodsThirty-nine batches of amber samples were collected and analyzed through integrated techniques including morphological analysis, microscopic identification, powder X-ray diffraction (XRD), Raman spectroscopy, Fourier-transform infrared (FTIR) spectroscopy, and inductively coupled plasma mass spectrometry (ICP-MS) to evaluate their morphological attributes, phase composition, molecular vibrational modes, and trace element profiles. Among them, the XRD experiment used Cu Kα radiation (λ=1.540 6 Å), with a scanning angle range of 10° to 70° (2θ) and a step size of 0.02°, the Raman spectroscopy experiment employed a 785 nm laser, with a spectral measurement range of 3 400 to 50 cm-1, a laser power of 300 mW, a laser intensity of 30%, and a scanning time of 100 to 1 000 ms, the infrared spectroscopy experiment used a carbon-sulfur lamp, with a scanning range of 4 000 to 500 cm-1, a resolution of 4 cm-1, and 3 scans, the ICP-MS experiment utilized frequency power of 1.2 kW, a double-pass cyclonic spray chamber, a sample introduction system flow rate of 0.7-1.0 L·min-1, and an auxiliary gas flow of 0.2 L·min-1. ResultsUnder orthogonal polarized light microscopy, medicinal amber exhibited an isotropic homogeneous structure, with partial samples containing inorganic impurities such as AsS and SiO₂. FTIR spectra revealed characteristic absorption peaks at 2 932-2 939 cm-1 (C-H stretching vibrations), 1 705-1 728 cm-1 (C=O stretching vibrations), and 880-887 cm-1 (C=C deformation vibrations), confirming the oxidative polymerization of terpenoid resin. Raman spectroscopy further identified distinctive peaks at 2 925 cm-1, 2 870 cm-1 (saturated C-H stretching), and 1 648 cm-1 (C=C stretching), consistent with the structural features of oxidized-polymerized resin. ICP-MS analysis demonstrated that S, Al, Si, Fe, Na, and Ca were the predominant trace elements in medicinal amber. ConclusionThis study comprehensively evaluated medicinal amber's morphological attributes, phase composition, molecular vibrational modes, and trace elements through multimodal analytical techniques. The findings establish data support for establishing quality standards for medicinal amber and distinguishing it from synthetic resin imitations.
6.Characterization of Medicinal Amber via Multispectral Analysis Combined with ICP-MS
Donghan BAI ; Zerun LI ; Xueying XIN ; Lu LUO
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(17):176-183
ObjectiveTo systematically investigate the identification characteristics of medicinal amber, elucidate its microscopic features, crystal structural properties, and elemental composition, and thereby provide a scientific foundation for quality control and authenticity verification. MethodsThirty-nine batches of amber samples were collected and analyzed through integrated techniques including morphological analysis, microscopic identification, powder X-ray diffraction (XRD), Raman spectroscopy, Fourier-transform infrared (FTIR) spectroscopy, and inductively coupled plasma mass spectrometry (ICP-MS) to evaluate their morphological attributes, phase composition, molecular vibrational modes, and trace element profiles. Among them, the XRD experiment used Cu Kα radiation (λ=1.540 6 Å), with a scanning angle range of 10° to 70° (2θ) and a step size of 0.02°, the Raman spectroscopy experiment employed a 785 nm laser, with a spectral measurement range of 3 400 to 50 cm-1, a laser power of 300 mW, a laser intensity of 30%, and a scanning time of 100 to 1 000 ms, the infrared spectroscopy experiment used a carbon-sulfur lamp, with a scanning range of 4 000 to 500 cm-1, a resolution of 4 cm-1, and 3 scans, the ICP-MS experiment utilized frequency power of 1.2 kW, a double-pass cyclonic spray chamber, a sample introduction system flow rate of 0.7-1.0 L·min-1, and an auxiliary gas flow of 0.2 L·min-1. ResultsUnder orthogonal polarized light microscopy, medicinal amber exhibited an isotropic homogeneous structure, with partial samples containing inorganic impurities such as AsS and SiO₂. FTIR spectra revealed characteristic absorption peaks at 2 932-2 939 cm-1 (C-H stretching vibrations), 1 705-1 728 cm-1 (C=O stretching vibrations), and 880-887 cm-1 (C=C deformation vibrations), confirming the oxidative polymerization of terpenoid resin. Raman spectroscopy further identified distinctive peaks at 2 925 cm-1, 2 870 cm-1 (saturated C-H stretching), and 1 648 cm-1 (C=C stretching), consistent with the structural features of oxidized-polymerized resin. ICP-MS analysis demonstrated that S, Al, Si, Fe, Na, and Ca were the predominant trace elements in medicinal amber. ConclusionThis study comprehensively evaluated medicinal amber's morphological attributes, phase composition, molecular vibrational modes, and trace elements through multimodal analytical techniques. The findings establish data support for establishing quality standards for medicinal amber and distinguishing it from synthetic resin imitations.
7.Exploring the Neuroprotective Effect of Dushu Pills Aβ25-35-induced AD Model Mice Based on Network Pharmacology
Hongyu SUN ; Zhengmin LI ; Luke ZHAI ; Boyu WANG ; Yuan LING ; Donghan ZHAO ; Juan ZHANG ; Zhenqiang ZHANG ; Zijuan ZHANG
World Science and Technology-Modernization of Traditional Chinese Medicine 2025;27(1):255-267
Objective To explore the effects of Dushu pills on cognitive ability and mitochondrial dynamics related proteins in mouse model of Alzheimer's disease(AD)based on network pharmacology.Methods The corresponding targets of Dushu pills and its related targets with AD were predicted using TCMSP database.The intersection targets of Dushu pills and AD were obtained by Venny website.The protein interaction network and drug-disease-target network were mapped using String database and Cytoscape software,respectively.GO and KEGG enrichment analysis were performed for intersection targets using David database.The mouse model of AD was established by injecting Aβ25-35 into bilateral ventricles.The learning and memory ability of the mice was detected by behavioral tests,the mitochondrial damage of neurons in the hippocampus was observed by transmission electron microscopy,and the expression of proteins related to mitochondrial dynamics was detected by Western blot.Results A total of 311 intersection targets related to drugs and diseases were screened out from the database.GO and KEGG analysis showed that the relevant targets were concentrated in mitochondria and other components,and concentrated in the pathways of ATP binding and positive regulation of MAPK activity.Compared with the normal group,the learning and memory ability of the model group was decreased(P<0.05),mitochondrial ridges appeared swelling and fracture(P<0.0001),decreased expression of MAPK,Mfn2 and OPA1 proteins in hippocampus(P<0.01),the expression of DRP1 protein increased(P<0.01).Compared with the model group,the learning and memory ability of mice in the medium and high dose groups of Dushu pills was improved(P<0.05),mitochondrial damage was significantly improved(P<0.01),increased expression of MAPK,Mfn2 and OPA1 in the hippocampus(P<0.01),DRP1 protein expression decreased(P<0.01).Conclusion Dushu pills can reduce mitochondrial damage,maintain mitochondrial homeostasis,and improve the cognitive and memory ability of AD mice.
8.Clinical and genetic analysis of a Chinese pedigree affected with Hereditary dentin dysplasia type II due to a variant of DSPP gene.
Fang LI ; Yingting YANG ; Yang LIU ; Weifeng TANG ; Hailan FENG ; Dong HAN
Chinese Journal of Medical Genetics 2025;42(11):1329-1336
OBJECTIVE:
To investigate the clinical characteristics and genetic etiology of a Chinese pedigree affected with Hereditary dentin dysplasia type II (DD-II) due to variant of dentin sialophosphoprotein (DSPP) gene.
METHODS:
A child diagnosed with DD- II at the Third Clinical Division of Peking University Hospital of Stomatology in December 2021 and her family members were selected as study subjects. Clinical data were retrospectively analyzed. Saliva samples were collected from the proband, her parents and sister for genomic DNA extraction. Whole exome sequencing (WES) was carried out. Candidate variant was verified by Sanger sequencing and TOPO-TA cloning sequencing. The candidate variant was also subjected to bioinformatics analysis using Mutation Taster v2021. Secondary and tertiary structures of the wild-type and variant DSPP proteins were predicted with psipred v4.0 and PyMOL v2.3 software, respectively. The pathogenicity of the variant was classified based on the guidelines from American College of Medical Genetics and Genomics (ACMG). This study was approved by the Medical Ethics Committee of Peking University Hospital of Stomatology (Ethics No.: PKUSSIRB-202162021).
RESULTS:
The proband and her mother and sister had all exhibited typical clinical manifestations of hereditary DD-II. The primary dentition of the proband displayed yellowish brown discoloration, wear, and obliteration in the chamber and root canal, while the permanent teeth of the proband's sister and mother appeared nearly normal in both color and appearance, though with obliteration in the chamber and root canal. Her father showed normal dentition. WES identified a heterozygous c.1915_1918delAAGT, p.(Lys639Glnfs*674) frameshift variant in the DSPP gene. Sanger sequencing and TOPO-TA cloning sequencing confirmed the presence of this variant in the proband, the proband's sister, and the mother, while the proband's father was negative for the variant, indicating an autosomal dominant inheritance pattern. The variant was predicted to be pathogenic by Mutation Taster v2021. Prediction of the secondary structure of the DSPP protein showed that the variant has changed it from coil to helix. The tertiary structure prediction of the DSPP protein showed change of the spatial structure of the variant DSPP, with the loops in the variant region replaced by helices at multiple sites. Based on the guidelines from the ACMG, the variant was classified as pathogenic (PVS1+PM2_Supporting+PP1+PP4).
CONCLUSION
Phenotypic analysis and genetic testing of this family has clarified the clinical diagnosis of hereditary DD- II. The c.1915_1918delAAGT variant probably underlay the pathogenesis of DD-II in this family. Above results have expanded the phenotypic spectrum of the disease and may contribute to further clinical and genetic research on this disease.
Humans
;
Pedigree
;
Female
;
Extracellular Matrix Proteins/chemistry*
;
Male
;
Sialoglycoproteins/chemistry*
;
Dentin Dysplasia/genetics*
;
Asian People/genetics*
;
Phosphoproteins/chemistry*
;
Child
;
Mutation
;
China
;
Exome Sequencing
;
Adult
;
East Asian People
9.A survey on the knowledge of Helicobacter pylori infection diagnosis and treatment among medical staff from general hospitals in Hainan Province
Hui ZHOU ; Guoning CHEN ; Yang GUO ; Yan TAN ; Cheng LAN ; Donghan WU ; Zhanliang MA ; Peng CHENG ; Cuiyi MO ; Ming WANG ; Peiyuan LI ; Ya LIN ; Yongqiang YANG ; Junling HAN ; Zhai CHEN ; Changling LIN ; Zhaona WU ; Shengxiong CHEN ; Zhengyi CHEN ; Xiaoxi HUANG
Chinese Journal of Digestion 2024;44(4):223-233
Objective:To investigate the knowledge of Sixth Chinese national consensus report on the management of Helicobacter pylori infection ( treatment excluded) (hereinafter referred to as sixth national consensus) and 2022 Chinese national clinical practice guideline on Helicobacter pylori eradication treatment (hereinafter referred to as the guideline)among medical staff from general hospitals in Hainan. Methods:From February 20 to May 7, 2023, a questionnaire survey on the diagnosis and treatment of Helicobacter pylori ( H. pylori) infection was conducted among 1 463 medical staff from 15 general hospitals in Hainan Province. The questionnaire was drawn up according to the sixth national consensus and the guideline, covering knowledge of 6 sections, induding H. pylori related diseases, detection of H. pylori, eradication, prevention and influence factors of eradication of H. pylori, etc. Chi-square test was used for statistical analysis. Results:A total of 1 463 valid questionnaires were collected with the effective responsive rate of 100.00%.The 1 463 subjects included 225 gastroenterologists and 1 238 other medical staff(including 503 physicians from other departments, 264 surgeons and 471 medical technologists and pharmacists). About 78.67%(177/225)of gastroenterologists agreed that the overall infection rate of H. pylori in China was more than 20%, the awareness rate was higher than that of other medical staff (physicians from other departments 65.41%(329/503), surgeons 61.74%(163/264), medical technologists and pharmacists 60.30%(284/471); the following datas were sorted by this position), and the difference was statistically significant ( χ2=30.97, P<0.001). About 51.11%(115/225) of gastroenterologists considered that H. pylori serological antibody test could not be used as a diagnostic method for current infection, the awareness rate was higher than that of other medical staff(22.07%(111/503), 14.02%(37/264), 12.31%(58/471)), and the difference was statistically significant( χ2 =152.66, P<0.001). Proton pump inhibitor and potassium-competitive acid blocker should be discontinued for 2 weeks, and antibiotics and bismuth should be discontinued for 4 weeks before urea breath test, and the awareness rates of gastroenterologists were higher than those of other medical staff (38.67%(87/225) vs. 23.26%(117/503), 19.70%(52/264), 18.47%(87/471); 60.89%(137/225) vs. 26.64%(134/503), 25.76%(68/264), 23.78%(112/471)), and the differences were statistically significant ( χ2 =133.70 and 165.51, both P<0.001). For refractory H. pylori infection, 98.67%(222/225)of gastroenterologists agreed with the individualized diagnosis and treatment of H. pylori infection should be guided by bacterial culture, antibiotic susceptibility test or drug resistance gene test, and the awareness rate was higher than that of other medical staff (91.85%(462/503), 93.56%(247/264), 93.21%(439/471)), and the difference was statistically significant( χ2=20.55, P=0.002). About 70.67% (159/225) of gastroenterologists recommended a bismuth containing quadruple regimen, 80.44% (181/225) supported a 10 to 14 day H. pylori eradication course, and the awareness rates were higher than other medical staff (46.92%(236/503), 33.33%(88/264), 32.91%(155/471); 67.20%(338/503), 59.09%(156/264), 53.93%(254/471)), and the differences were statistically significant ( χ2=111.25 and 59.99, both P<0.001). The understanding rates of the sixth national consensus and the guideline in gastroenterologists was 85.33% (192/225), which was higher than that of other medical staff (64.21%(323/503), 66.67%(176/264), 57.96%(273/471)), and the difference was statistically significant ( χ2=85.47, P<0.001). Conclusions:Gastroenterologists from general hospitals in Hainan Province have a better understanding of the sixth national consensus and the guideline than other medical staff. However, there is still a lack of deep understanding of the sixth national consensus and the guideline, and it is necessary to further strengthen the learning and application of the sixth national consensus and the guideline.
10.Application value of intrathoracic esophagogastric anastomosis with double-flap technique in combined thoracoscopic and laparoscopic radical resection for esophagogastric junction cancer
Jingtao ZHU ; Hexin LIN ; Qingqi HONG ; Yinan CHEN ; Yifu CHEN ; Yongwen LI ; Donghan CHEN ; Huangdao YU ; Haibin WANG ; Jun YOU
Chinese Journal of Digestive Surgery 2023;22(10):1226-1232
Objective:To investigate the application value of intrathoracic double-flap tech-nique (Kamikawa anastomosis) in combined thoracoscopic and laparoscopic radical resection for esophagogastric junction cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 10 patients with esophagogastric junction cancer who were admitted to the First Affiliated Hospital of Xiamen University between July 2022 and April 2023 were collec-ted. There were 7 males and 3 females, aged 62(range, 53-71)years. All the 10 patients underwent combined thoracoscopic and laparoscopic radical resection for esophagogastric junction cancer. Reconstruction was performed with an intrathoracic Kamikawa anastomosis. Observation indicators: (1) intraoperative and postoperative situations; (2) postoperative pathological examination; (3) follow-up and survival. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Intraoperative and postoperative situations. All the 10 patients underwent surgery successfully. The operation time and volume of intraoperative blood loss were (347±41)minutes and (91±41)mL. The time to postoperative fluid diet intake, time to removal of postoperative abdominal drainage tube, time to removal of postoperative chest drainage tube, duration of postoperative hospital stay were (4.3±1.1)days, (5.0±1.6)days, (10.5±3.9)days, (13.3±3.8)days. Six patients had postoperative complications, including 1 case of Clavien-Dindo grade ⅢB, 3 cases of Clavien Dindo grade Ⅱ, 2 cases of Clavien Dindo grade Ⅰ. An upper gastrointestinal contrast at postoperative day 7 showed no anastomotic leak or anastomotic stricture in the 10 patients. (2) Postoperative pathological examination. Results of postoperative pathological examination in the 10 patients showed negative surgical margin. The number of lymph node dissected was 22±6. There were 3 patients with 5 positive lymph nodes. The tumor diameter and distance from center of tumor to squamocolumnar mucosal junction were (3.3±0.5)cm and (1.9±1.4)cm. One patient had tumor differentiation degree as high and moderate differentiation, 5 cases as moderate differentiation, 3 cases as moderate and low differentiation, 1 case as low differentiation. There were 5 patients with squamous cell carcinoma of the esophagogastric junction and 5 patients with adenocarcinoma of the esophagogastric junction. (3) Follow-up and survival. All the 10 patients were followed up for 7(range, 3?12)months, achieving disease-free survival. The visick quality of life grade Ⅰ, Ⅱ, Ⅲ, Ⅳ were observed in 7, 3, 0, 0 patients. Postoperative gastroscopy was completed in 7 patients, in which mild anastomotic strictures were noted in 2 patients, but no treatment was required. There was no reflux esophagitis.Conclusion:Intrathoracic Kamikawa anastomosis in combined thoracoscopic and laparoscopic radical resection for esophagogastric junction cancer is safe and feasible, with satisfactory short-term efficacy.

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