Objective To compare the safety of laparoscopic pancreatoduodenectomy(LPD)and open pancreatoduodenectomy(OPD)and analyze the learning curve and safety at different stages of LPD.Methods A retrospective analysis was conducted on the clinical data of 50 LPD patients and 54 OPD patients in the Department of Hepatopancreatobiliary Surgery of Suzhou Hospital Affiliated to Nanjing Medical University from January 2020 to June 2024,and intraoperative and postoperative conditions were compared.The Cumulative Sum(CUSUM)analysis method was used to analyze the technical nodes of the LPD learning curve.Results There were no significant differences in operation time and intraoperative blood loss between the LPD group and the OPD group(P＞0.05).There was also no significant difference in the incidence rates of pancreatic fistula(grade B and C),delayed gastric emptying,postoperative bleeding,biliary fistula and intra-abdominal infection between the LPD group and the OPD group(P＞0.05).A time series plot of operation time was drawn based on the patient's operation time and surgical sequence,yielding a fitted curve.Curve analysis showed initial stage and stable stage were finished at the 17th and 24th cases.The LPD learning curve could be divided into three stages:stage Ⅰ characterized as the initial stage(cases 1 to 17),stage Ⅱ characterized as the stable stage(cases 18 to 24),and stage Ⅲ characterized as the proficient stage(cases 25 to 50).The operation time in stages Ⅱ and Ⅲ was significantly shorter than that in stage Ⅰ,and the intraoperative blood loss in stage Ⅰ was significantly higher than that in stage Ⅲ(P＜0.05).There was no significant difference in the incidence of complications among the three stages(P＞0.05).Conclusion LPD and OPD show no significant differences in indications and safety.The LPD learning curve can be divided into three stages.As the number of surgeries completed increa-ses,the operation time of physicians gradually shortens,and the incidence of complications of patients gradually decreases.

Objective:To investigate the clinical difference between primary suture and T tube drainage in laparoscopic choledocholithotomy.Methods:The clinical data of 124 patients treated by laparoscopic choledocholithotomy in Suzhou Municipal Hospital from December 2018 to February 2020 were retrospectively studied. The patients were divided into the primary suture group (71 cases) and the T tube drainage group (53 cases) according to the different surgical methods, and the differences in the relevant treatment indicators were compared between the two groups.Results:There were no statistically significant differences between the two groups in gender, hypertension, diabetes mellitus, preoperative aspartate aminotransferase, preoperative alanine aminotransferase, preoperative total bilirubin, preoperative common bile duct diameter, postoperative length of stay, total cost of hospitalization, postoperative exhaust time, or postoperative biliary leakage, et al. Compared with the T tube drainage group, the primary suture group had more single choledocholithiasis before operation (33 cases vs. 15 cases), shorter operation time: (100.14 ± 38.90) h vs. (140.45 ± 54.17) h, less intraoperative bleeding: (35.70 ± 30.17) ml vs. (49.53 ± 34.58) ml, and later extraction time of Winslow hole drainage tube after operation: (7.15 ± 2.61) d vs. (5.45 ± 3.35) d, and the differences were statistically significant ( P<0.05). Conclusions:Under the condition of strictly controlling the indications of primary suture and being operated by general surgeons who can skillfully operate laparoscope and choledochoscope, laparoscopic choledocholithotomy for primary suture has better curative effect than T tube drainage, and has higher clinical application value.

Objective:To investigate the clinical value of ankle-brachial index (ABI) in evaluating vascular cognitive dysfunction (VCI) in the elderly.Methods:According to the mini mental state examination (MMSE) and Montreal cognitive assessment (MoCA), 200 elderly inpatients from May 2016 to February 2018 in our hospital were selected. MoCA scale was used to evaluate the cognitive function of the patients. The patients were divided into cognitive dysfunction group ( n=110) and cognitive normal group ( n=90). The clinical data of the two groups were analyzed and compared. The correlation between ABI and MMSE, MOCA and clinical indicators was observed. The receiver operating characteristic (ROC) curve of ABI value to the predictive value of VCI in the elderly was drawn. Results:⑴ There was no significant difference between the two groups in terms of gender, the first fasting blood glucose value in hospital and the situation of diabetes, hypertension and hyperlipidemia ( P>0.05); there was significant difference in age, low-density lipoprotein cholesterol (LDL-C) level, history of small cerebral vessels and ABI between the two groups ( P<0.05). ⑵ Logistic regression analysis showed that ABI was the related factor of VCI in the elderly ( P<0.01). ⑶ Pearson correlation analysis showed that MMSE score was positively correlated with ABI ( r=0.887, P<0.01), MOCA score was positively correlated with ABI ( r=0.843, P<0.01). ⑷ The area under ROC curve of ABI prediction value for VCI in the elderly was (0.965±0.01) [95% CI (0.945, 0.985), P<0.01]. When ABI ≤0.9, the sensitivity and specificity were 88.2%, 91.1% respectively; the accuracy and the yordan index were 89.5% and 0.793. Conclusions:⑴ ABI is an influencing factor of VCI in the elderly and is positively correlated with the severity of cognitive impairment in patients. ⑵ ABI has a high predictive value for VCI of the elderly, and ABI≤0.9 can be used as an early warning factor for VCI of the elderly.

Objective To research the clinical application value of laparoscopic bile duct exploration and the first stage suture for choledocholithiasis. Methods The clinical data of 86 patients with choledocholithiasis were analyzed retrospectively from January 2015 to January 2017 in Affiliated Suzhou Hospital of Nanjing Medical University. According to the different methods of laparoscopic bile duct exploration, they were divided into one stage suture group (observation group, 46 cases) and T tube drainage group (control group, 40 cases). Results The recovery time of gastrointestinal function, hospitalization time and hospitalization expenses in observation group were significantly better than those in control group: (22.71 ± 10.92) h vs. (35.63 ± 11.12) h, (8.4 ± 2.6) d vs. (13.5 ± 2.3) d and (12.1 ± 3.2) thousand yuan vs. (13.5 ± 4.2) thousand yuan, and there were statistical differences (P＜0.05). Conclusions Compared with T tube drainage, the first stage suture after laparoscopic common bile duct exploration has shorter hospitalization time, lower treatment cost and faster recovery. It is a safe and feasible operation method, and is worthy of popularization and application.

Objective To investigate the effects of huaier granules on invasion and metastasis of colorectal cancer SW480 cells in vitro, and explore the basic mechanism. Methods The appropriate concentration and duration of huaier granules promoting SW480 cell apoptosis were determined by SubG1 method. Wound healing assay and transwell assay were used to observe the effect of huaier granules on SW480 cell invasion and metastasis. The changes of E-cadherin, twist, snail and vimentin at protein and mRNA levels were examined by Western blotting and Real-Time PCR. Results After treatment with huaier granules at 3. 0 g·L-1 for 36 h, apoptosis of SW480 cells was most significant, and wound healing assay revealed that relative mobility was (31. 36±2. 39)%, compared with (61. 11±1. 09)% in control group (P<0. 01). Number of invaded cells per field of view was (129±12) in treatment group and (354±20) in control group (P<0. 01). After treatment with huaier granules at 3. 0 g·L-1 for 36 h, protein and mRNA levels of E-cadherin were increased, while those of twist, snail and vimentin were decreased. Conclusion Huaier granules can inhibit invasion and metastasis of colorectal cancer SW480 cells in vitro through effectively depressing epithelial-mesenchymal transition.

The need analysis of information resource for appropriate health technologies is important for the related information transmission channel and promotion of those technologies at primary level.This paper introduces the current status of the information resource construction of appropriate health technologies in China,and analyzes the needs and means of transmission in terms of users,holders and spreader,taking Zhejiang as an example.Methods of literature review,questionnaire survey,interview,and symposium were employed.