Objective:To investigate the application value of robotic-assisted surgery for pancreatic cancer after neoadjuvant chemotherapy (NAT).Methods:The retrospective and descrip-tive study was conducted. The clinicopathological data of 10 pancreatic cancer patients who underwent robotic-assisted surgery after NAT at The First Affiliated Hospital of Sun Yat-sen University from November 2021 to January 2025 were collected. There were 7 male and 3 female, aged (62±7)years. Observation indicators: (1) NAT conditions; (2) intraoperative conditions; (3) postoperative condi-tions; (4) follow-up. 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. The Kaplan-Meier method was used to calculate survival time. Results:(1) NAT conditions. Of the 10 patients, 4 cases had tumor surrounding the portal vein or superior mesenteric vein more than 180° (no invasion of superior mesenteric artery), 3 cases had concomitant hepatic oligometastasis, and 3 cases had tumor invasion of adjacent organ (2 cases with tumor invasion of left kidney, 1 case with tumor invasion of duodenum). Nine of the 10 patients received chemotherapy of gemcitabine+albumin-paclitaxel, and the other 1 patient received chemo-therapy of fluorouracil + irinotecan + oxaliplatin. After treatment, 3 patients were evaluated as partial remission and 7 patients were evaluated as stable disease. (2) Intraoperative conditions. Of the 10 patients, 5 cases received robotic-assisted pancreatoduodenectomy and 5 cases received robotic-assisted radical antegrade modular pancreatosplenectomy, with no case converted to open surgery. There were 3 cases receiving combined vascular resection and reconstruction, including 2 cases with portal vein resection plus side wall repairing and 1 case with superior mesenteric vein resection plus end to end anastomosis. There were 2 cases receiving combined other organ resection intra-operatively, including 1 case with local hepatectomy and 1 case with left nephrectomy. The operation time of 10 patients was 465(range, 195?565)minutes, volume of intraoperative blood loss was 70(range, 20?350)mL. One case with preoperative anemia required red blood cell transfusion during the operation, while the other cases did not receive any transfusion during the operation. All 10 patients achieved R 0 resection and the number of lymph node dissected was 12±8. Three patients who underwent combined vascular resection and reconstruction had negative margin of the portal vein or superior mesenteric vein. (3) Postoperative conditions. Duration of postoperative hospital stay of 10 patients was (15±8)days, and 1 case developed major complications in grade Ⅲa of Clavein-Dindo classfication. Of the 10 patients, 1 case developed grade B pancreatic fistula, 1 case experienced delayed gastric emptying, and no case had postoperative biliary fistula, chyle leakage, abdominal or anastomotic bleeding, no case underwent reoperation, no case died within postoperative 30 days. (4) Follow-up. All 10 patients were followed up after surgery for 10.0(range, 2.7?40.4)months. All 10 patients underwent postoperative adjuvant chemotherapy, and the time from surgery to the start of adjuvant chemotherapy was (40±12)days. The median overall survival time of 10 patients was 30.4 months, and the median recurrence-free survival time was 10.9 months. Conclusion:Robotic-assisted surgery can be used for pancreatic cancer after neoadjuvant chemotherapy.

Objective:To investigate the application value of robotic-assisted surgery for pancreatic cancer after neoadjuvant chemotherapy (NAT).Methods:The retrospective and descrip-tive study was conducted. The clinicopathological data of 10 pancreatic cancer patients who underwent robotic-assisted surgery after NAT at The First Affiliated Hospital of Sun Yat-sen University from November 2021 to January 2025 were collected. There were 7 male and 3 female, aged (62±7)years. Observation indicators: (1) NAT conditions; (2) intraoperative conditions; (3) postoperative condi-tions; (4) follow-up. 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. The Kaplan-Meier method was used to calculate survival time. Results:(1) NAT conditions. Of the 10 patients, 4 cases had tumor surrounding the portal vein or superior mesenteric vein more than 180° (no invasion of superior mesenteric artery), 3 cases had concomitant hepatic oligometastasis, and 3 cases had tumor invasion of adjacent organ (2 cases with tumor invasion of left kidney, 1 case with tumor invasion of duodenum). Nine of the 10 patients received chemotherapy of gemcitabine+albumin-paclitaxel, and the other 1 patient received chemo-therapy of fluorouracil + irinotecan + oxaliplatin. After treatment, 3 patients were evaluated as partial remission and 7 patients were evaluated as stable disease. (2) Intraoperative conditions. Of the 10 patients, 5 cases received robotic-assisted pancreatoduodenectomy and 5 cases received robotic-assisted radical antegrade modular pancreatosplenectomy, with no case converted to open surgery. There were 3 cases receiving combined vascular resection and reconstruction, including 2 cases with portal vein resection plus side wall repairing and 1 case with superior mesenteric vein resection plus end to end anastomosis. There were 2 cases receiving combined other organ resection intra-operatively, including 1 case with local hepatectomy and 1 case with left nephrectomy. The operation time of 10 patients was 465(range, 195?565)minutes, volume of intraoperative blood loss was 70(range, 20?350)mL. One case with preoperative anemia required red blood cell transfusion during the operation, while the other cases did not receive any transfusion during the operation. All 10 patients achieved R 0 resection and the number of lymph node dissected was 12±8. Three patients who underwent combined vascular resection and reconstruction had negative margin of the portal vein or superior mesenteric vein. (3) Postoperative conditions. Duration of postoperative hospital stay of 10 patients was (15±8)days, and 1 case developed major complications in grade Ⅲa of Clavein-Dindo classfication. Of the 10 patients, 1 case developed grade B pancreatic fistula, 1 case experienced delayed gastric emptying, and no case had postoperative biliary fistula, chyle leakage, abdominal or anastomotic bleeding, no case underwent reoperation, no case died within postoperative 30 days. (4) Follow-up. All 10 patients were followed up after surgery for 10.0(range, 2.7?40.4)months. All 10 patients underwent postoperative adjuvant chemotherapy, and the time from surgery to the start of adjuvant chemotherapy was (40±12)days. The median overall survival time of 10 patients was 30.4 months, and the median recurrence-free survival time was 10.9 months. Conclusion:Robotic-assisted surgery can be used for pancreatic cancer after neoadjuvant chemotherapy.

Objective:To investigate the short-term outcomes of robot-assisted pancreato-duodenectomy (RPD) performed by one single surgeon.Methods:The retrospective and descriptive study was conducted. The clinico-pathological data of 240 patients who were performed RPD by one single surgeon at The First Affiliated Hospital of Sun Yat-sen University from July 2016 to October 2023 were collected. There were 130 males and 110 females, aged 59(19)years. All RPD were performed by the same surgeon. Observation indicators: (1) surgical situations; (2) postoperative pathological examination and outcome of patients. Measurement data with normal distribution were expressed as Mean± SD, and measurement data with skewed distribution were expressed as M(IQR). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations. Of 240 patients, 15 cases underwent combined vascular resection and reconstruction, and 13 patients were combined with other operations simultaneously. Of 240 patients, 4 cases converted to open surgery, with the conversion rate as 1.67%. The operation time of 240 patients was 458(152)minutes, volume of intraopera-tive blood loss was 50(50)mL, intraoperative erythrocyte transfusion was required in 17 patients. The R 0 resection rate was 99.17%(238/240), the number of lymph nodes harvested was 10(6) and duration of postoperative hospital stay was 17(12)days. (2) Postoperative pathological examination and outcome of patients. Of 240 patients, 51 cases were pancreatic ductal adenocarcinoma, 41 cases were ampullary carcinoma, 41 cases were neuroendocrine neoplasms, 35 cases were pancreatic cystic neoplasms, 28 cases were duodenal carcinoma and 44 cases were other pathologic types. Of 99 patients with major complications, there were 57 cases with clinically relevant postoperative pancreatic fistula, 44 cases with postoperative delayed gastric empty, 11 cases with postoperative biliary fistula, 8 cases with postoperative chyle fistula, 14 cases with incision infec-tion, and 24 cases with postoperative hemorrhage. Multiple complications might occur to the same patient. Reoperation was performed in 6 of the 240 patients. One patient died within 30 days after surgery. Twenty-four patients returned to hospital within 30 days after discharge. Conclusions:RPD performed by one single surgeon is safe and feasible, with favorable short-term outcomes, which can be performed in medical centers with experiences in robot-assisted pancreatic surgery.

Objective:To explore the application effect of preoperative autologous blood localization method in laparoscopic resection of gastric stromal tumors in unfavorable areas of the stomach.Methods:A retrospective analysis was conducted on the case data of 40 patients with gastric stromal tumors in unfavorable locations admitted to Jinjiang Hospital from January 2019 to December 2022. The patients were divided into a control group (intraoperative endoscopic localization method) and an autologous blood localization group according to different intraoperative lesion localization methods, with 20 cases in each group. The surgical time, intraoperative blood loss, hospitalization time, postoperative exhaust time, and adverse reactions were compared between the two groups.Results:The surgery time of the autologous blood localization group was shorter than that of the control group [(92.30±8.80)min vs (108.20±14.87)min, P<0.05]. There was no statistically significant difference in intraoperative bleeding, hospitalization time, and postoperative exhaust time between the two groups (all P>0.05). Two groups of patients did not show an increase in inflammatory indicators such as white blood cells and C-reactive protein on the day after surgery. Both groups of patients did not experience adverse reactions such as fever, abdominal pain, or postoperative complications. Conclusions:The autologous blood injection localization method provides a safe, simple, and effective method for preoperative localization of gastric stromal tumors in unfavorable areas of the stomach under laparoscopy, and is worthy of clinical promotion and use.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Humans ; Nitric Oxide ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Lung Neoplasms ; Lung ; Nitric Oxide Synthase ; Macrophages, Alveolar ; Pulmonary Alveoli

OBJECTIVE: To investigate the prevalence of vitamin D deficiency and its association with blood eosinophil count in healthy population and patients with chronic obstructive pulmonary disease (COPD). METHODS: We analyzed the data of a total 6163 healthy individuals undergoing routine physical examination in our hospital between October, 2017 and December, 2021, who were divided according to their serum 25(OH)D level into severe vitamin D deficiency group (< 10 ng/mL), deficiency group (< 20 ng/mL), insufficient group (< 30 ng/mL) and normal group (≥30 ng/mL). We also retrospectively collected the data of 67 COPD patients admitted in our department from April and June, 2021, with 67 healthy individuals undergoing physical examination in the same period as the control group. Routine blood test results, body mass index (BMI) and other parameters were obtained from all the subjects, and logistic regression models were used to investigate the association between 25(OH)D levels and eosinophil count. RESULTS: The overall abnormal rate of 25(OH)D level (< 30 ng/mL) in the healthy individuals was 85.31%, and the rate was significantly higher in women (89.29%) than in men. Serum 25(OH)D levels in June, July, and August were significantly higher than those in December, January, and February. In the healthy individuals, blood eosinophil counts were the lowest in severe 25(OH)D deficiency group, followed by the deficiency group and insufficient group, and were the highest in the normal group (P < 0.05). Multivariable regression analysis showed that an older age, a higher BMI, and elevated vitamin D levels were all risk factors for elevated blood eosinophils in the healthy individuals. The patients with COPD had lower serum 25(OH)D levels than the healthy individuals (19.66±7.87 vs 26.39±9.28 ng/mL) and a significantly higher abnormal rate of serum 25(OH)D (91% vs 71%; P < 0.05). A reduced serum 25(OH)D level was a risk factor for COPD. Blood eosinophils, sex and BMI were not significantly correlated with serum 25(OH)D level in patients with COPD. CONCLUSION Vitamin D deficiency is common in both healthy individuals and COPD patients, and the correlations of vitamin D level with sex, BMI and blood eosinophils differ obviously between healthy individuals and COPD patients.
Male ; Humans ; Female ; Eosinophils ; Retrospective Studies ; Leukocyte Count ; Body Mass Index ; Pulmonary Disease, Chronic Obstructive

Objective:To evaluate the safety and short-term efficacy of robotic-assisted resection for Bismuth-Corlette type Ⅲ and Ⅳ perihilar cholangiocarcinoma in Department of Pancreatobiliary Surgery,The First Affiliated Hospital,Sun Yat-sen University Methods:The clinical data of Bismuth-Corlette type Ⅲ and Ⅳ perihilar cholangiocarcinoma patients who have undergone robotic-assisted resection at The First Affiliated Hospital,Sun Yat-sen University between July 2017 and May 2023 were retrospectively studied.The clinicopathological features and perioperative outcomes of the patients were analyzed. Results:A total of 9 patients with Bismuth-Corlette type Ⅲ or Ⅳ perihilar cholangiocarcinoma,including 4 type Ⅲa patients,4 type Ⅲ b patients and 1 type Ⅳ patient,received robotic-assisted resection.1 patient converted to open surgery.The median operation time was 645 min[interquartile range(IQR):554-745 min],the median intraoperative blood loss was 300 mL(IQR:150-650 mL),and the median number of lymph node retrieval was 11(IQR:6-12).7 patients(77.8％)had R0 resection.5 patients(55.6％)had postoperative major complications(Clavein-Dindo classification was Ⅲ-Ⅴ),including intra-abdominal infection in 2 patients,liver function failure in 2 patients and upper gastrointestinal bleeding in 1 patient.1 patient underwent reoperation for the jejuno-jejunostomy bleeding 19 d after the initial operation and achieved good recovery.1 patient died within 30 d after initial operation due to liver function failure.The median length of postoperative hospital stay was 18 d(IQR:10-32 d). Conclusion:Robotic-assisted resection for Bismuth-Corlette type Ⅲ and Ⅳ perihilar cholangio-carcinoma is technically feasible and safe with good short-term efficacy,and can be performed in large-volume centers with ample experience in robotic-assisted hepatopancreatobiliary surgery.

OBJECTIVE: To investigate the association of the time of initial diagnosis with the severity of chronic obstructive pulmonary disease (COPD). METHODS: A total of 803 patients who were diagnosed to have COPD for the first time in our hospital between May 2015 to February 2018 were enrolled in this study.The diagnoses of COPD and asthma COPD overlap (ACO) were made according GOLD guidelines and european consensus definition.Lung function of the patients was graded according to the GOLD guidelines. RESULTS: The patients with COPD had a mean age of 61.8±9.9 years,including 726 male and 77 female patients.The course of the patients (defined as the time from symptom onset to the establishment of a diagnosis) was 3(0.5,8) years.Among these patients,85.2% had a moderate disease severity (FEV1%<80%),and 48.3% had severe or very severe conditions (FEV1%<50%);47.0% of them were positive for bronchial dilation test.In the overall patients,295(36.7%) were also diagnosed to have ACO,and the mean disease course of ACO[3(1,9) years]was similar to that of COPD[3(0.5,8) years](>0.05).A significant correlation was found between the disease course and the lung function of the patients.Multiple linear regression analysis showed that an older age and a longer disease course were associated with poorer lung functions and a greater disease severity. CONCLUSIONS The delay of the initial diagnosis is significantly related to the severity of COPD.
Age Factors ; Aged ; Asthma ; diagnosis ; Delayed Diagnosis ; adverse effects ; Disease Progression ; Female ; Humans ; Lung ; physiopathology ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; physiopathology ; Severity of Illness Index ; Time Factors

Objective: To investigate the correlation between the stenosis degree of superior mesenteric artery (SMA) and each artery within the scope of aorto-iliac artery in patients with lower extremity atherosclerotic occlusive disease (LEAOD). Methods: Images of 70 patients who had undergone the aorta-iliac-femoral arteries CT angiography (CTA) examination and had a definite diagnosis of LEAOD due to intermittent claudication or resting pain admitted to Tianjin Hospital from January to December in 2017 were enrolled. The arteries in the aorta as well as iliac were surface-reconstructed, which were analyzed by advanced vascular analysis (AVA) combined with the original images, including SMA trunk, abdominal aorta (AA), left and right common iliac artery (LCIA, RCIA), left and right internal iliac artery (LIIA, RIIA), left and right external iliac artery (LEIA, REIA). The normal reference plane and the maximal stenosis plane were selected, and the stenosis rate of each artery in the reconstruction range was automatically calculated with software. The patient's imaging data were divided into groups with two methods: ① according to the degree of SMA stenosis, the patients were divided into group Ⅰ (stenosis degree ≤70%) and groupⅡ (stenosis degree > 70%); ② LEAOD patients with different gender were respectively divided into three groups: middle-aged group (45-59 years old), pre-elderly group (60-74 years old) and elderly group (75-89 years old). The comparison between the stenosis degree of SMA and each artery within the scope of aorto-iliac artery was analyzed with Pearson simple correlation analysis. Results: The incidence of SMA stenosis in all LEAOD patients was 100%. Correlation analysis showed that there was no correlation between the stenosis degree of SMA and AA, LCIA, RCIA, LIIA, RIIA, LEIA, or REIA in group Ⅰ (n = 64) and group Ⅱ (n = 6), respectively (r value was -0.021, 0.023, 0.023, -0.137, 0.182, -0.113, 0.141, respectively, in group Ⅰ, and it was 0.020, -0.560, 0.010, 0.306, -0.204, -0.381, 0.393, respectively, in group Ⅱ, all P > 0.05). In 52 male patients, there was no correlation between the stenosis degree of SMA and AA, LCIA, RCIA, LIIA, RIIA, LEIA, or REIA in middle-aged group (n = 16), pre-elderly group (n = 27) and elderly group (n = 9), respectively (r value was -0.032, 0.024, 0.324, 0.146, 0.312, 0.008, 0.344, respectively, in middle-aged group, it was -0.108, -0.116, -0.040, -0.249, -0.082, -0.052, 0.096, respectively, in pre-elderly group, and it was 0.182, 0.311, 0.400, 0.360, 0.688, 0.498, 0.406, respectively, in elderly group, all P > 0.05). In 18 female patients, there was also no correlation between the stenosis degree of SMA and above each artery within the scope of aorto-iliac artery in pre-elderly group (n = 11) and elderly group (n = 6), respectively (the r value was -0.170, 0.040, -0.019, 0.152, 0.508, 0.042, 0.456, respectively, in pre-elderly group, and it was -0.660, 0.008, -0.055, -0.056, -0.213, 0.344, 0.011, respectively, in elderly group, all P > 0.05). The correlation in middle-aged group was not analyzed because there was only 1 patient. Conclusions Although the atherosclerotic changes in LEAOD patients can affect SMA and aorto-iliac artery at the same time, there was no correlation between the stenosis degree of SMA and each artery within the scope of aorto-iliac artery which may due to the differences in the histological structure and hemodynamics among different arteries. SMA atherosclerotic stenosis and occlusion is a relatively independent disease process for LEAOD.