Objective:To investigate the safety and efficacy of laparoscopic fundoplication in the treatment of gastroesophageal reflux related cough (GERC).Methods:Clinical data of 138 GERC patients undergoing laparoscopic fundoplication at our center from Jan 2013 to Dec 2017 were analyzed and patients were followed up until Dec 2022.Results:A total of 138 patients underwent surgery successfully.The median follow-up time was 51 (7-130) months.There were no mortality,nor major complications. In 138 GERC patients, GERC was cured in 85 patients,the cure rate of fundoplication was 61.6%, and altogether 112 patients reported effective, the effective rate was 81.2%. Multivariate regression analysis showed that normal esophageal peristalsis was independent predictors of good efficacy of fundoplication[ OR=3.810(1.373,10.573), P=0.01]. Conclusions:Laparoscopic fundoplication has long term efficacy for refractory GERC. Esophageal motility is an important dynamic characteristic that affects the postoperative efficacy of GERC.

Objective:To investigate the safety and efficacy of laparoscopic fundoplication in the treatment of gastroesophageal reflux related cough (GERC).Methods:Clinical data of 138 GERC patients undergoing laparoscopic fundoplication at our center from Jan 2013 to Dec 2017 were analyzed and patients were followed up until Dec 2022.Results:A total of 138 patients underwent surgery successfully.The median follow-up time was 51 (7-130) months.There were no mortality,nor major complications. In 138 GERC patients, GERC was cured in 85 patients,the cure rate of fundoplication was 61.6%, and altogether 112 patients reported effective, the effective rate was 81.2%. Multivariate regression analysis showed that normal esophageal peristalsis was independent predictors of good efficacy of fundoplication[ OR=3.810(1.373,10.573), P=0.01]. Conclusions:Laparoscopic fundoplication has long term efficacy for refractory GERC. Esophageal motility is an important dynamic characteristic that affects the postoperative efficacy of GERC.

Objective:To explore the long-term efficacy of laparoscopic fundoplication for proton pump inhibitor dependent gastroesophageal reflux disease (GERD).Method:Clinical data of proton pump inhibitor dependent GERD patients who underwent fundoplication at the Rocket Force Characteristic Medical Center from Jan to Jun 2012 were analyzed, including GERD symptom score, subjective symptom relief rate, PPI discontinuation rate and surgical satisfaction, as well as recurrence and complications.Result:A total of 160 GERD patients were included in this study, with 64% of patients having respiratory symptoms. Nissen and Toupet fundoplication were performed in 43 and 117 cases, respectively, with a follow-up time of (127±3) months. The postoperative GERD symptom scores of the patients were significantly lower than before treatment (all P<0.001); The subjective relief of overall symptoms in the digestive tract and airway problem was 90% (80%, 100%) and 100%, respectively. The PPI discontinuation rate was 86%, and the overall satisfaction rate of the treatment was 92%, and the satisfaction rate of patients with respiratory symptoms was 89%. 7% of patients experienced varying degrees of symptomatic recurrence, 4% of patients re-underwent endoscopic treatment and/or laparoscopic fundoplication due to symptom recurrence. The incidence of long-term postoperative dysphagia, bloating, belching, increased exhaust, abdominal pain, diarrhea, and constipation were 11.3%, 16.9%, 0, 1.3%, 0, 2.5%, and 5.6%, respectively. Conclusions:Laparoscopic fundoplication has good long-term efficacy in the treatment of GERD. A small number of patients may experience postoperative recurrence, as well as complications such as dysphagia and gas-bloat syndrome. Most recurrent patients can achieve good therapeutic effect by redoing endoscopic treatment or redoing surgery.

Objective:To summarize the clinical manifestations, electrophysiological, muscle magnetic resonance imaging (MRI), pathological, and genetic characteristics of 8 patients with Emery-Dreifuss muscular dystrophy (EDMD) to improve the recognition and diagnosis of EDMD.Methods:Eight patients with EDMD confirmed by gene analysis admitted to Hebei Medical University Third Hospital from 2011 to 2022 were enrolled. The detailed clinical symptoms, neurophysiological examination, electrophysiological changes (electromyography and electrocardiography), skeletal muscle MRI characters, skeletal muscle pathological features and gene mutations were analyzed retrospectively.Results:The age of onset ranged from 2.0 to 6.0 (3.6±1.2) years. All patients had insidious onset and progressive development. Muscle weakness was the first symptom for 7 cases that manifested as difficulty in squatting and walking up stairs. Later, spinal ankylosis and joint contracture occurred. One patient had scoliosis as the first symptoms. Abnormal electrocardiogram was found in 4 cases. The electromyography of all patients showed myogenic damage. Muscle biopsy demonstrated dystrophic features in 1 patient, and other myopathic features, including a variation in muscle fiber size, a marked increase in internal nuclei, and, smaller diameter of typeⅠfibers. Next-generation sequencing result showed that 6/8 cases carried 4 LMNA heterozygous mutations (c.1583C>G, c.1357C>T, c.148C>T, c.1336A>G); 1/8 case carried EMD hemizygous mutation (c.501C>G); 1/8 carried SYNE1 heterozygous mutation (c.4364G>A). Conclusions:EDMD has highly clinical and genetical heterogeneity. The onset age is usually in childhood. The first symptom is characterized by weakness of lower limbs and abnormal walking posture. Electromyography shows myogenic lesion. Skeletal muscle MRI shows selective fat infiltrations. Muscle biopsy pathology lacks characteristic pathological findings. It is difficult to make diagnosis and differential diagnosis by clinical manifestations and auxiliary examination in the early stage of the disease. The second generation sequencing technology can improve the early diagnosis rate of EDMD.

The cholinergic anti-inflammatory pathway (CAP) is an important neuroimmunomodulatory mechanism that innervates the spleen through vagus nerve efferent and splenic nerve relay, and acts on macrophages by transforming adrenergic stimulation into cholinergic signal by spleen T cells, which plays an anti-inflammatory effect, and maintains the balance of inflammatory response. Due to the critical role of the imbalance of pro-inflammatory and anti-inflammatory responses in the physiological process of sepsis, regulating the activity of the CAP has become an important focus in the treatments of sepsis. Based on the understanding of the CAP, vagus nerve stimulation, drug agonists mimicking cholinergic signals, and acupuncture are currently applied in the research and exploration of sepsis treatment. This article summarizes the recent progress and prospects of the CAP mechanism, biological effects, and application in sepsis treatment.

Objective:To evaluate the performance and the accuracy of surgical robot for mandibular reconstruction based on intelligent surgical planning.Methods:115 CT scanning images of normal mandible (57 males, 48 females, 40.3±9.1 years old, from February 2010 to May 2019) and 115 CT scanning images of mandible with tumor (62 males, 53 females, 55.6±7.2 years old, from March 2008 to August 2019) from Shanghai Ninth People’s Hospital were selected. The surgical robot system including work station, UR robot, optical navigation system, 6 dimensional force senor and surgical instrument. A 3D V-Net for mandible preoperational segmentation from CT scans was proposed and used to segment the mandible of a 54-year-old male patient who received mandible reconstruction with fibular flaps. The machine learning algorithm was used to aid surgical planning for maxillo-mandibular defect by detecting landmarks. The accuracy was defined as the distance between corresponding landmarks on the intact mandible. The robot could locate the target according to surgical planning and perform fibula osteotomy through force-motion control. The CT scanning of limb and head from the patient (male, 54 years old) was used for phantom experiments. 30 osteotomies on 5 3D-priented resin phantom were carried out. The pre- and post-operative images were compared to calculate the accuracy. The descriptive results were in the format of Mean±SD.Results:The average accuracy of V-Net for mandible segmentation was 96.581% and the time cost was less than 30 seconds. The average error of feature points on mandible was (2.24±1.74) mm. The residual length error was (1.02±0.45) mm and angle error was (0.96±0.42) degree in robotic-assisted osteotomy according to 3 cases of phantom experiments. The surgical robot could perform osteotomy safely and steadily within 15 min.Conclusions:Intelligent surgical planning can precisely segment the mandible and determine its landmarks. Robot for mandibular reconstruction can perform fibular osteotomy precisely with the pre-operative planning.

Objective:To analyze the stress and displacement distribution of mandibular reconstruction with fibular flap by fixation based on mortise and tenon joint structure with three-dimensional finite element analysis.Methods:A 66-year-old male patient with no fracture or deformity of the mandible was admitted to the Department of Oral and Maxillofacial Head and Neck Oncology of the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine in August 2020. The imaging data of the mandible and fibula of the patients were obtained with CT scan. Three-dimensional reconstruction and reverse reconstruction were performed with software Mimics 17.0 and GeomagicWrap 2017 to obtain the three-dimensional models of the mandible and fibula. The model of mandibular reconstruction with fibular flap was obtained by software Solidworks 2017 and Geomagic Design X 64. The cortical bone and cancellous bone were segmented by Boolean operation. The vertical occlusal state was simulated (the loading condition was 125 N downward along the axis of the central incisor and 250 N downward along the axis of the second and third molars). Three dimensional finite element analysis was used to compare and analyze the stress and displacement distribution characteristics of the mandible and internal fixation before and after bone healing with the mortise and tenon joint structure combined with lag screws and traditional titanium plates. After optimized the boundary conditions of the mandible based on the mortise and tenon joint structure, the stress and displacement distribution of the internal fixation and mandible were measured.Results:In terms of stress distribution, under the condition of bone non-union, the stress peak of the internal fixator fixed by mortise and tenon structure was distributed at the junction of bone section and internal fixator, which was 304.07 MPa. The peak stress of the titanium plate fixation was 345.39 MPa at the broken end of the posterior bone. After bone healing, the stress peak distributions of the internal fixator fixed by mortise and tenon structure remained unchanged, which was 58.47 MPa. The stress of the internal fixator was concentrated to the contact point between the titanium nail and the titanium plate, which was 92.06 MPa.In addition, after the boundary conditions were optimized, the stress distribution of the bones was uniform, and the peak stress of internal fixation was 88.56 MPa, which was significantly lower than the maximum yield strength of titanium (860 MPa). In terms of displacement, under the condition of bone non-union, the displacement peaks of the two fixation methods were both located in the right mental foramen in the middle of the lower margin of the mandible and involved the anterior osteotomy surface. The peak value of mandible displacement in tenon and mortise fixation was 1.307 mm, which was slightly lower than that in titanium plate fixation, 1.447 mm.After bone healing, the main displacements of the two fixation methods were located close to the middle of the lower margin of the mandible and did not involve the osteotomy surface. The displacement peak value of titanium plate fixed mode was 0.518 mm, which was less than that of tenon and mortise fixed mode. Under the condition of bone non-union, the peak displacement of the mandible was 0.212 mm after the boundary of the tenon and mortise fixation model was optimized.Conclusions:The tenon and mortise design combined with lag screw fixation is a safe and effective method for the mandible reconstruction with a fibular flap.

Objective:To evaluate the performance and the accuracy of surgical robot for mandibular reconstruction based on intelligent surgical planning.Methods:115 CT scanning images of normal mandible (57 males, 48 females, 40.3±9.1 years old, from February 2010 to May 2019) and 115 CT scanning images of mandible with tumor (62 males, 53 females, 55.6±7.2 years old, from March 2008 to August 2019) from Shanghai Ninth People’s Hospital were selected. The surgical robot system including work station, UR robot, optical navigation system, 6 dimensional force senor and surgical instrument. A 3D V-Net for mandible preoperational segmentation from CT scans was proposed and used to segment the mandible of a 54-year-old male patient who received mandible reconstruction with fibular flaps. The machine learning algorithm was used to aid surgical planning for maxillo-mandibular defect by detecting landmarks. The accuracy was defined as the distance between corresponding landmarks on the intact mandible. The robot could locate the target according to surgical planning and perform fibula osteotomy through force-motion control. The CT scanning of limb and head from the patient (male, 54 years old) was used for phantom experiments. 30 osteotomies on 5 3D-priented resin phantom were carried out. The pre- and post-operative images were compared to calculate the accuracy. The descriptive results were in the format of Mean±SD.Results:The average accuracy of V-Net for mandible segmentation was 96.581% and the time cost was less than 30 seconds. The average error of feature points on mandible was (2.24±1.74) mm. The residual length error was (1.02±0.45) mm and angle error was (0.96±0.42) degree in robotic-assisted osteotomy according to 3 cases of phantom experiments. The surgical robot could perform osteotomy safely and steadily within 15 min.Conclusions:Intelligent surgical planning can precisely segment the mandible and determine its landmarks. Robot for mandibular reconstruction can perform fibular osteotomy precisely with the pre-operative planning.

Objective:To analyze the stress and displacement distribution of mandibular reconstruction with fibular flap by fixation based on mortise and tenon joint structure with three-dimensional finite element analysis.Methods:A 66-year-old male patient with no fracture or deformity of the mandible was admitted to the Department of Oral and Maxillofacial Head and Neck Oncology of the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine in August 2020. The imaging data of the mandible and fibula of the patients were obtained with CT scan. Three-dimensional reconstruction and reverse reconstruction were performed with software Mimics 17.0 and GeomagicWrap 2017 to obtain the three-dimensional models of the mandible and fibula. The model of mandibular reconstruction with fibular flap was obtained by software Solidworks 2017 and Geomagic Design X 64. The cortical bone and cancellous bone were segmented by Boolean operation. The vertical occlusal state was simulated (the loading condition was 125 N downward along the axis of the central incisor and 250 N downward along the axis of the second and third molars). Three dimensional finite element analysis was used to compare and analyze the stress and displacement distribution characteristics of the mandible and internal fixation before and after bone healing with the mortise and tenon joint structure combined with lag screws and traditional titanium plates. After optimized the boundary conditions of the mandible based on the mortise and tenon joint structure, the stress and displacement distribution of the internal fixation and mandible were measured.Results:In terms of stress distribution, under the condition of bone non-union, the stress peak of the internal fixator fixed by mortise and tenon structure was distributed at the junction of bone section and internal fixator, which was 304.07 MPa. The peak stress of the titanium plate fixation was 345.39 MPa at the broken end of the posterior bone. After bone healing, the stress peak distributions of the internal fixator fixed by mortise and tenon structure remained unchanged, which was 58.47 MPa. The stress of the internal fixator was concentrated to the contact point between the titanium nail and the titanium plate, which was 92.06 MPa.In addition, after the boundary conditions were optimized, the stress distribution of the bones was uniform, and the peak stress of internal fixation was 88.56 MPa, which was significantly lower than the maximum yield strength of titanium (860 MPa). In terms of displacement, under the condition of bone non-union, the displacement peaks of the two fixation methods were both located in the right mental foramen in the middle of the lower margin of the mandible and involved the anterior osteotomy surface. The peak value of mandible displacement in tenon and mortise fixation was 1.307 mm, which was slightly lower than that in titanium plate fixation, 1.447 mm.After bone healing, the main displacements of the two fixation methods were located close to the middle of the lower margin of the mandible and did not involve the osteotomy surface. The displacement peak value of titanium plate fixed mode was 0.518 mm, which was less than that of tenon and mortise fixed mode. Under the condition of bone non-union, the peak displacement of the mandible was 0.212 mm after the boundary of the tenon and mortise fixation model was optimized.Conclusions:The tenon and mortise design combined with lag screw fixation is a safe and effective method for the mandible reconstruction with a fibular flap.

Objective:To evaluate the effect of sufentanil on activation of Schwann cells after peripheral nerve injury in mice.Methods:Eighty healthy pathogen-free male Balb/c mice, aged 6-8 weeks, weighing 18-22 g, were divided into 4 groups ( n=20 each) using a random number table method: peripheral nerve injury group (group PNI), high dose sufentanil group (group H), medium dose sufentanil group (group M) and low dose sufentanil group (group L). The model of unilateral sciatic nerve transaction was established in ketamine-anesthetized mice.Immediately after establishment of the model, sufentanil 10, 5 and 2.5 μg/kg was injected intraperitoneally once a day for 3 consecutive days in H, M and L groups, respectively, while the equal volume of normal saline was given instead in group PNI.Sciatic function index (SFI) was calculated at 4, 8 and 12 weeks after establishment of the model.At 2, 4, 8 and 12 weeks, 5 mice in each group were sacrificed, and segments of the injuried ipsilateral sciatic nerve were removed for examination of the ultrastructure of the sciatic nerve (with a transmission electron microscope) and for detection of the expression of glial fibrillary acidic protein (GFAP) of sciatic nerve (by immunohistochemistry). Results:Compared with group PNI, SFI was significantly increased, and the expression of GFAP was up-regluated at each time point after establishment of the model in H and M groups ( P<0.05) and no significant change was found in SFI and GFAP expression after establishment of the model in group L ( P>0.05). Compared with group L, SFI was significantly increased, and GFAP expression was up-regluated in H and M groups ( P<0.05). There was no significant difference in SFI and GFAP expression between group H and group M ( P>0.05). The thickness of myelin lamellae was dense, and the proliferation of Schwann cells was not marked in H and M groups.The thickness of myelin lamellae was thin, and the proliferation of Schwann cells was marked in L and MO groups. Conclusion:The mechanism by which sufentanil improves repair after peripheral nerve injury may be related to promoting activation of Schwann cells in mice.