Objective:To investigate the feasibility of employing high-resolution colon manometry (HRCM) in conjunction with natural orifice specimen extraction surgery (NOSES) during laparoscopic Jinling surgery for the treatment of colonic slow transit constipation (STC).Methods:This study retrospectively analyzed data from nine patients with STC who underwent HRCM preoperative evaluation and subsequently received NOSES Jinling surgery at Tianjin Union Medical Center between October 2016 and March 2023. The general intraoperative conditions and postoperative evaluation indicators were recorded.Results:All 9 patients underwent HRCM examination before surgery. High amplitude propagation contraction (HAPC) was observed in the ascending colon segment of all patients. The occurrence frequency of HAPC was 4.22±1.86 (times/day). The operation time of 9 patients was 200.0 (167.5, 250.0) minutes, the intraoperative blood loss was 100 (50, 150) ml, the postoperative hospitalization time was 13.0 (12.5, 24.0) days, and the first postoperative exhaust time was 3.0 (2.0, 3.5) days, the first postoperative defecation time was 5.0 (4.5, 5.5) days, the first postoperative eating time was 5.0 (5.0, 5.5) days, and the first postoperative time out of bed was 5.0 (5.0, 8.0) days. Notably, none of the 9 patients experienced postoperative complications. The Wexner scores at 6 months [5 (4, 7)], and 12 months [4 (3, 5)] post-surgery were significantly lower than the preoperative score [20 (16, 21)] ( P<0.05). Additionally, the patient assessment of constipation quality of life (PAC-QOL) scores at 6 months [22 (20, 25)], and 12 months [18 (12, 45)] after surgery showed a significant decrease compared to preoperative scores [79 (72, 82)] ( P<0.05). Conclusions:The combination of HRCM preoperative assessment and NOSES Jinling surgery is both safe and feasible for the treatment of slow transit constipation, warranting further development and promotion.

Objective:To investigate the feasibility of employing high-resolution colon manometry (HRCM) in conjunction with natural orifice specimen extraction surgery (NOSES) during laparoscopic Jinling surgery for the treatment of colonic slow transit constipation (STC).Methods:This study retrospectively analyzed data from nine patients with STC who underwent HRCM preoperative evaluation and subsequently received NOSES Jinling surgery at Tianjin Union Medical Center between October 2016 and March 2023. The general intraoperative conditions and postoperative evaluation indicators were recorded.Results:All 9 patients underwent HRCM examination before surgery. High amplitude propagation contraction (HAPC) was observed in the ascending colon segment of all patients. The occurrence frequency of HAPC was 4.22±1.86 (times/day). The operation time of 9 patients was 200.0 (167.5, 250.0) minutes, the intraoperative blood loss was 100 (50, 150) ml, the postoperative hospitalization time was 13.0 (12.5, 24.0) days, and the first postoperative exhaust time was 3.0 (2.0, 3.5) days, the first postoperative defecation time was 5.0 (4.5, 5.5) days, the first postoperative eating time was 5.0 (5.0, 5.5) days, and the first postoperative time out of bed was 5.0 (5.0, 8.0) days. Notably, none of the 9 patients experienced postoperative complications. The Wexner scores at 6 months [5 (4, 7)], and 12 months [4 (3, 5)] post-surgery were significantly lower than the preoperative score [20 (16, 21)] ( P<0.05). Additionally, the patient assessment of constipation quality of life (PAC-QOL) scores at 6 months [22 (20, 25)], and 12 months [18 (12, 45)] after surgery showed a significant decrease compared to preoperative scores [79 (72, 82)] ( P<0.05). Conclusions:The combination of HRCM preoperative assessment and NOSES Jinling surgery is both safe and feasible for the treatment of slow transit constipation, warranting further development and promotion.

Objective:To optimize the formula of aprepitant nanocapsules. Methods: The central composite design–response surface methodology was used. The amounts of hydroxg propyl cellulose(HPC-SL) and sodium dodecyl sulfate(SDS) were set as the independent variables;the dissolution of aprepitant capsules at 15min and 30min, and the dissolution after accelerated at 40℃ and 75% RH for 6 months were set as the dependent variables. Quadratic polynomial mathematic models were used to evaluate the relation-ship between the independent and the dependent variables. According to the mathematic models,an effect graph was drawn. The opti-mized formula was chosen from the overlap of the contour graphs of the dependent variables. The similarity of in vitro dissolution curve was evaluated by using f2factor. Results:The correlation coefficient of quadratic polynomial mathematic model and the reliability was high. The measured values of the optimized formula were within the expected ranges. Conclusion: Aprepitant nanocapsules with the optimized formula by central composite design-response surface methodology meet the requirements. The results can provide evidence for the next industrial production.

OBJECTIVETo compare clinically relevant postoperative complications after open, laparoscopic, and robotic gastrectomy for gastric cancer.

METHODSClinical data of patients with gastric cancer who underwent gastrectomy between January 1, 2014 and October 1, 2016 at Chinese People's Liberation Army General Hospital were analyzed retrospectively. All the patients were diagnosed by upper endoscopy and confirmed by biopsy without distant metastasis. They were confirmed with R0 resection by postoperative pathology. Patients with incomplete data were excluded. The complications among open group, laparoscopic group and robotic group were compared. The continuous variables were analyzed by one-way ANOVA, and categorical variables were analyzed by χtest or Fisher exact test.

RESULTSA total of 1 791 patients (1 320 males and 471 females) were included in the study, aged from 17 to 98 (59.0±11.6) years, comprising 922 open, 673 laparoscopic and 196 robotic gastrectomies. There were no significant differences among three groups in baseline data (gender, age, BMI, comorbidity, radiochemotherapy) and some of operative or postoperative data (blood transfusion, number of lymph node dissection, combined organ resection, resection site, N stage, postoperative hospital stay). The blood loss in laparoscopic and robotic groups was significantly lower than that in open group[(185.7±139.6) ml and (194.0±187.6) ml vs. (348.2±408.5) ml, F=59.924, P=0.000]. The postoperative complication occurred in 197 of 1 791(11.0%) patients. The Clavien-Dindo II(, III(a, III(b, IIII(a, and IIIII( complications were 5.5%, 4.0%, 1.2%, 0.1%, and 0.2% respectively. The anastomotic leakage (2.4%), intestinal obstruction(1.3%) and pulmonary infection(1.2%) were the three most common complications, followed by wound infection(0.8%), cardiovascular disease(0.7%), anastomotic bleeding (0.7%), delayed gastric emptying (0.6%), duodenal stump fistula(0.5%), intraperitoneal hemorrhage (0.5%), pancreatic fistula (0.3%), intra-abdominal infection(0.2%), chylous leakage (0.1%) and other complications(1.7%). There were no significant differences among three groups as the complication rates of open, laparoscopic and robotic gastrectomy were 10.6%(98/922), 10.8%(73/673) and 13.3%(26/196) respectively (χ=1.173, P=0.566). But anastomotic leakage occurred more common after laparoscopic and robotic gastrectomy compared to open gastrectomy [3.1%(21/673) and 5.1%(10/196) vs. 1.3%(12/922), χ=12.345, P=0.002]. The rate of cardiocerebral vascular diseases was higher in open group[1.3%(12/922) vs. 0.1%(1/673) and 0, χ=8.786, P=0.012]. And the rate of anastomotic bleeding was higher in robotic group [2.0%(4/196) vs. open 0.4%(4/922) and laparoscopic 0.6%(4/673), χ=6.365, P=0.041]. In view of Clavien-Dindo classification, III(a complications occurred more common in laparoscopic group [5.5%(37/673) vs. open 3.3%(30/922) and robotic 2.6%(5/196), χ=6.308, P=0.043] and III(b complications occurred more common in robotic group [3.1%(6/196) vs. open 1.1%(10/922) and laparoscopic 0.7%(5/673), χ=7.167, P=0.028].

CONCLUSIONSMorbidities of postoperative complications are comparable among open, laparoscopic and robotic gastrectomy for gastric cancer. However, in consideration of the high difficulty of anastomosis, the minimally invasive surgery should be performed by more experienced surgeons.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak ; epidemiology ; etiology ; Blood Loss, Surgical ; statistics & numerical data ; Cerebrovascular Disorders ; epidemiology ; etiology ; Chylous Ascites ; epidemiology ; etiology ; Comorbidity ; Comparative Effectiveness Research ; Duodenal Diseases ; epidemiology ; etiology ; Female ; Gastrectomy ; adverse effects ; methods ; Gastrointestinal Hemorrhage ; epidemiology ; etiology ; Gastroparesis ; epidemiology ; etiology ; Gastroscopy ; Hemoperitoneum ; epidemiology ; etiology ; Humans ; Intestinal Fistula ; epidemiology ; etiology ; Intraabdominal Infections ; epidemiology ; etiology ; Laparoscopy ; adverse effects ; Length of Stay ; Lymph Node Excision ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; etiology ; Postoperative Hemorrhage ; epidemiology ; etiology ; Postoperative Period ; Respiratory Tract Infections ; epidemiology ; etiology ; Retrospective Studies ; Risk Assessment ; Robotic Surgical Procedures ; adverse effects ; Stomach Neoplasms ; surgery ; Surgical Wound Infection ; epidemiology ; etiology

OBJECTIVE:To promote the standardization and rationality of medical order for chemotherapeutic drugs,and im-prove its safety use in clinic. METHODS:Through developing the investigation of relevant status quo,the design factors and infor-mation that should be involved and considered of the medical order management module for chemotherapeutical drugs in hospital-ized information system(HIS)were determined. The reference standard chemotherapy regimen used in medical orders was put for-ward. The basic data was maintained and menu setting was conducted. Based on HIS,the function module of automatically import-ing patients'information,drug and program selection,warning were designed;the docking and effective application of medical or-der management module for chemotherapeutical drugs in hospital medical order management information system was achieved. Its application effects were evaluated by summarizing monthly irrational rate of medical orders within 2 years. RESULTS & CONCLU-SIONS:The medical order management module for chemotherapeutical drugs developed in our hospital can achieve physician autho-rized management,automatically importing patient-related information,preservative chemotherapy regimen for easy entry and selec-tion. The irrational numbers of chemotherapy orders were decreased from 28 orders (1.15%) in prime (Jun. 2014) to 4 orders (0.14%)2 years later(Jun. 2016). Procedures of medical orders for chemotherapeutical drugs are standardized,initially realize in-formation management,improve input efficiency and accuracy of medical orders,which have provided protection and support for standardizing physicians'diagnosis and treatment behavior and avoiding the hospital risk,and promote correct,safe and rational use of chemotherapeutic drugs.

Objective To explore the value of acoustic radiation force impulse imaging (ARFI) technique in the evaluation of the change of kidney in rabbits with hypothermia and rewarming. Methods Sixteen New Zealand rabbits were placed in -25 ℃ environment for 8 hours, then rewarmed in 23℃ environment. Ultrasonic examinations were performed at room temperature in the time of T0and the time of T1-T8. The right kidney were evaluated by two-dimensional ultrasound and ARFI technique. Results No significant changes were found in the echo and volume of kidney from T1to T8. SWV of kidney descended greatly from T0to T1and raised from T2to T3gradually, then it descended from T3to T8gradually. Significant difference of SWV of kidney were found from T1to T8compared with that at T0(P < 0.05). Conclusions ARFI Technique can estimate the change of kidney in rabbits with hypothermia and rewarming. It can provide more useful information for clinical diagnosis.

Objective:To optimize the formula of regorafenib solid dispersion .Methods: On the basis of preliminary studies on the carrier and drug/carrier ratio, an orthogonal test was used to study the formula of regorafenib solid dispersion .The orthogonal table of L9 (34 ) was designed to study the drug/carrier ratio, ultrasound time and bath temperature .Results: Regorafenib solid dispersion was prepared by a solvent method with polyvinylpyrrolidone K 30 as the carrier.The drug/carrier ratio was 1 ∶7, the ultrasound time was 4min, and the bath temperature was 30℃.Regorafenib solid dispersion showed good stability confirmed by differential scanning calorimetry and X-ray diffraction .The dissolution in 30 min reached above 90 %.Conclusion: The preparation process is stable and reproducible , which can be used to prepare regorafenib solid dispersion .

Objective To reproduce an animal model of acute hepatic failure at high altitude areas for use in the research of extracorporeal artificial liver support. Methods General condition, survival time, relevant biochemistry indexes and pathological changes of the pigs treated by two peritoneal injections of thioacetamide in the dose of 50mg/kg, 100mg/kg and 150mg/kg respectively. Results All the pigs in the 3 experimental groups displayed clinical symptoms and signs and biochemistry changes similar to that of human patients with acute hepatic failure, and the 100mg/kg group may be the most ideal model. Conclusion The animal model of pig treated with two peritoneal injections of thioacetamide 100mg/kg is suitable for the research of extracorporeal artificial liver support for hepatic failure at high altitude.

Objective To investigate the change of biological features of macrophages after transfected by Toxoplasma gondii GRA 1 genes (P24). Methods The transfected cells Cyto P24 RAW264.7, Nuc P24 RAW264.7, Mito P24 RAW264.7 and ER P24 RAW264.7 were studied by RT PCR to determine the P24 mRNA expression. Growth features of the cells were examined with microscopy and the cell growth curve was developed. Results In four cell lines, expression of ER P24 RAW 264.7 was found to be higher than the other three, and there was no P24 mRNA expression in either of the cells without P24 insert. The attachment and the proliferation of ER-P24-RAW264.7 were more rapid than normal RAW264.7. Conclusion Transfection of mouse macrophages ER RAW264.7 strain with T. gondii P24 gene leads to a prominent change of biological features in the studied cell line.

Objective To explore the effect of phenol oxidase antigen on liver pathologic change in mice infected with Schistosoma japonicum. Methods 42d-aged adult worms were incubated in RPMI 1640 containing 0.05% sodium phenobarbital for 8 h. The worms were washed three times with PBS (pH 6.8) and homogenized with a Teflon pestle. The homogenate was then centrifuged at 3000 g for 20 min at 4 ℃. Supernatant fractions containing phenol oxidase (PO) were analyzed by means of polyacrylamide gel electrophoresis (PAGE). The rude antigen of PO was obtained by cutting the corresponding gel of PO activities. Three groups were set up to observe whether PO could induce protective immunity: experiment group, adjuvant control group and water control group. On day 42 post infection with (40?1) cercariae of Schistosoma japonicum, the mice were sacrificed to observe liver pathologic changes. Results The liver surface of PO immunized group was rather smooth and the liver color was slightly gray. A few pale nods were seen indistinctly but not clearly. Necrosis and inflammatory cell infiltration were not clear. There were many immature eggs without granuloma reaction. The mean diameter and area of the granuloma in the experiment group were less than those in the control group. There were significant differences among the 3 groups (P