Objective:To evaluate the short-term outcomes of robotic double-flap technique following proximal gastrectomy in patients with carcinoma of esophagogastric junction(AEG).Methods:Clinical data of 5 AEG cases undergoing robotic double-flap technique following proximal gastrectomy were analyzed at the Department of Gastrointestinal Surgery, Peking University First Hospital from Dec 2023 to Aug 2024 .Results:All the 5 patients were of Siewert Ⅱ type AEG. Robot-assisted radical proximal gastrectomy and esophagogastric double-flap anastomosis were successfully completed. The operation time was (361±63) min, the installation time was (21±11) min, the anastomosis time was (90±21) min, and the median intraoperative blood loss was 100 (50,200) ml. The median number of intraoperative lymph nodes resected was 23 (14,32), the first postoperative exhaust time was (4.8±1.1) d, and postoperative hospital stay was (14.6±8.8) d. Postoperative abdominal distension occurred in 1 patient, and no significant anastomotic stenosis or anastomotic leakage was observed by upper gastroenterography. After conservative treatment, the patient recovered. None of them had Clavien-Dindo grade ≥Ⅲ complications. There were no anastomotic complications such as anastomotic leakage, anastomotic hemorrhage and anastomotic stenosis.Conclusion:Robotic double-flap technique following proximal gastrectomy is a safe and effective treatment for AEG.

Objective:To evaluate the short-term outcomes of robotic double-flap technique following proximal gastrectomy in patients with carcinoma of esophagogastric junction(AEG).Methods:Clinical data of 5 AEG cases undergoing robotic double-flap technique following proximal gastrectomy were analyzed at the Department of Gastrointestinal Surgery, Peking University First Hospital from Dec 2023 to Aug 2024 .Results:All the 5 patients were of Siewert Ⅱ type AEG. Robot-assisted radical proximal gastrectomy and esophagogastric double-flap anastomosis were successfully completed. The operation time was (361±63) min, the installation time was (21±11) min, the anastomosis time was (90±21) min, and the median intraoperative blood loss was 100 (50,200) ml. The median number of intraoperative lymph nodes resected was 23 (14,32), the first postoperative exhaust time was (4.8±1.1) d, and postoperative hospital stay was (14.6±8.8) d. Postoperative abdominal distension occurred in 1 patient, and no significant anastomotic stenosis or anastomotic leakage was observed by upper gastroenterography. After conservative treatment, the patient recovered. None of them had Clavien-Dindo grade ≥Ⅲ complications. There were no anastomotic complications such as anastomotic leakage, anastomotic hemorrhage and anastomotic stenosis.Conclusion:Robotic double-flap technique following proximal gastrectomy is a safe and effective treatment for AEG.

Objective:To investigate the efficacy of Tanzhuo Decoction in the treatment of early diabetic nephropathy in patients with type 2 diabetes mellitus and its effect on cystatin C (Cys-C), C-reactive protein (CRP), urinary albumin excretion rate (UAER), and creatinine clearance rate (CCr). Methods:Eighty patients with type 2 diabetes mellitus complicated by early diabetic nephropathy who received treatment at Maanshan Hospital of Traditional Chinese Medicine from 2019 to 2021 were included in this randomized controlled study. They were divided into a control group ( n = 40) and a treatment group ( n = 40) using the random number table method. Patients in the control group received conventional therapy including blood glucose and blood pressure control, while those in the treatment group received Tangzhuo Decoction in addition to the same treatment as that given to the control group. Both groups of patients were treated for 30 days. The clinical efficacy as well as pre- and post-treatment Cys-C, CRP, UAER, and CCr were compared between the two groups. Results:The total response rate in the treatment group was 92.5% (37/40), which was significantly higher than 75.0% (30/40) in the control group ( χ2 = 4.50, P < 0.05). After treatment, Cys-C, CRP, and UAER in the treatment group were (2.04 ± 0.08) mg/L, (3.97 ± 1.71) mg/L, and (91.18 ± 18.68) μg/min, respectively, which were significantly decreased compared with those before treatment ( t = 12.14, 5.59, 4.73, all P < 0.05). After treatment, CCr in the treatment group was (56.3 ± 5.01) mL/min, which was significantly increased compared with that before treatment ( t = -8.56, P < 0.05). After treatment, Cys-C, CRP, and UAER in the control group were (2.17 ± 0.04) mg/L, (4.66 ± 1.47) mg/L, and (103.93 ± 22.62) μg/min, respectively, which were significantly decreased compared with those before treatment ( t = 4.05, 5.00, 2.24, all P < 0.05). After treatment, CCr in the control group was (45.9 ± 4.9) mL/min, which was significantly increased compared with that before treatment ( t = -3.98, P < 0.05). There were significant differences in Cys-C, UAER, and CCr between the treatment and control groups ( t = -7.42, -2.29, 7.82, all P < 0.05). Conclusion:Tanzhuo Decoction for the treatment of early diabetic nephropathy in patients with type 2 diabetes mellitus has a definite effect. It can effectively reduce levels of Cys-C and UAER, reduce inflammatory reactions, improve kidney function, and delay the progression of kidney injury.

Objective To assess the clinical utility of measurement of plasma heparin-binding protein (HBP) in diagnosis and prognosis of sepsis.Methods This is a retrospective study on the performance of plasma heparin-binding protein, procalcitonin and C-reaction protein in the early diagnosis of sepsis. Thirty-one patients with sepsis, 16 patients with severe sepsis, 12 patients with septic shock and 37 control patients without confirmed sepsis, all admitted to the Intensive Care Units (ICU) of the Third Hospital Affiliated to Wenzhou Medical University and Wenzhou Central Hospital from August 2014 to November 2016, were enrolled in the study. The plasma level of HBP, procalcitonin (PCT) and C-reactive protein (CRP) were measured, and the detailed clinical data were retrieved from the patient chart records for all patients described above. Comparison of each laboratory and clinical parameters between groups was carried out by Non-parameter Test. The efficiency of each parameter was calculated by receiver operating characteristics curves (ROC) analysis. The correlation between HBP, PCT or CRP and clinical or other laboratory parameters was explored using Spearman correlation analysis.Results HBP was significantly elevated in patients with severe sepsis[(100.65±58.82)ng/ml and(31.86±36.87)ng/ml,Z=-3.856,P<0.05;(100.65±58.82)ng/ml and(24.96±17.49)ng/ml,Z=-3.556,P<0.05]and in patients with septic shock[(148.28±99.73)ng/ml and(31.86±36.87)ng/ml,Z=-4.432,P<0.05;(148.28±99.73)ng/ml and(24.96±17.49)ng/ml,Z=-4.157,P<0.05], respectively, while CRP[(154.64±62.90)mg/L and(92.56±67.49)mg/L,Z=-2.749,P<0.05;(154.64±62.90)mg/L and (79.21±51.80)mg/L,Z=-3.218,P<0.05]and PCT[(32.86±39.93)ng/ml and(2.70±6.24)ng/ml,Z=-3.395,P<0.05;(32.86±39.93)ng/ml and(4.21±14.94)ng/ml,Z=-4.092,P<0.05]were increased only in patients with septic shock (P<0.05).For HBP, the area of under the ROC curves (AUC) was the biggest (AUC=0.687), indicating the clinical significance(P<0.05) with excellent sensitivity(0.729) at the optimal cut-off value(18.58 ng/ml). In addition, HBP(APTT: r=0.244, P=0.016;PT: r=0.351, P<0.001;INR: r=0.314, P=0.002;D-Dimer: r=0.334, P=0.001;lactic acid: r=0.394, P<0.001), CRP(APTT: r=0.271, P=0.008;PT: r=0.348, P=0.001;INR: r=0.264, P=0.009;D-Dimer: r=0.257, P=0.012;lactic acid: r=0.329, P=0.001) and PCT(APTT: r=0.375, P<0.001;PT: r=0.523, P<0.001;INR: r=0.535, P<0.001;D-Dimer: r=0.254, P=0.013;lactic acid: r=0.422, P<0.001)were positively correlated to coagulation function and to lactate.Conclusion HBP could probably be acted as an important biomarker for diagnosis and prognosis for patients with sepsis, esp., for patients with severe sepsis and septic shock.