ObjectiveTo explore the regulatory effects and mechanisms of Astragali Radix polysaccharide （APS） on inhibitor of differentiation1 （ID1） and protein kinase B （Akt） in gastric cancer. MethodsImmunohistochemical staining was used to detect the expression of ID1 and Akt in 61 gastric cancer tissue samples and 20 adjacent normal gastric tissue samples. Immunofluorescence was used to detect the localization of ID1 and Akt. The effects of APS at the concentrations of 0.625， 1.25， 2.5， 5， 10， 20 mg·L^-1 on the proliferation of gastric cancer MGC-803 cells were examined by the cell counting kit-8（CCK-8） method and the colony formation assay. The target information of APS was retrieved from the Traditional Chinese Medicine Systems Pharmacology and Analysis Platform and Swiss Target Prediction. Keywords such as gastric cancer， gastric tumor， and stomach cancer were searched against GeneCards， UniProt， DisGeNET， and Online Mendelian Inheritance in Man （OMIM） for the screening of gastric cancer-related targets. The online tool jvenn was used to create the Venn diagram to identify the common targets， and STRING and Cytoscape were used to construct the protein-protein interaction network. Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analyses were conducted via R 4.2.2 to predict the potential roles of APS in the development of gastric cancer. The cell scratch assay was employed to assess the effect of APS on the migration of MGC-803 cells. The protein and mRNA levels of ID1 and Akt in the cells treated with APS were determined by Western blot and Real-time PCR， respectively. ResultsCompared with the adjacent normal gastric tissue， the gastric adenocarcinoma tissue showed increased positive expression of ID1 （χ² =81.00， P<0.01）. Immunofluorescence detection showed that ID1 and Akt were mainly located in the cytoplasm of gastric adenocarcinoma cells. Bioinformatics analysis identified 14 common genes shared between APS and gastric cancer. The average degree of protein-protein interaction network nodes was 14.29. GO and KEGG pathway enrichment results showed that ID1 and Akt were significantly enriched in the Rap1 and phosphatidylinositol-3-kinase （PI3K） /Akt signaling pathways. Cell experiments demonstrated that 5-fluorouracil （0.1 mg·L^-1） and APS （10， 20 mg·L^-1） groups showed decreased cell proliferation， migration， and colony formation. Compared with the control group， 10， 20 mg·L^-1 APS inhibited the proliferation of MGC-803 cells （P<0.01）， with 10 mg·L^-1 APS demonstrating stronger inhibitory effect. In addition， APS at 10， 20 mg·L^-1 inhibited the migration （P<0.01） and colony formation （P<0.05， P<0.01） of MGC-803 cells. Compared with the control group， APS at 10， 20 mg·L^-1 down-regulated the protein levels of ID1 （P<0.01） and Akt （P<0.05） and the mRNA levels of ID1 （P<0.05， P<0.01） and Akt （P<0.05， P<0.01） in MGC-803 cells. ConclusionID1 and Akt are highly expressed in the gastric adenocarcinoma tissue， which may be related to the development of gastric cancer. APS can down-regulate the protein and mRNA levels of ID1 and Akt to exert anti-tumor effects， which is expected to provide new therapeutic targets for gastric cancer treatment.

Objective:To sinicize the English version of the rapid eye movement sleep behavior disorder symptom severity scale (RBDSSS) and to evaluate the reliability and validity of the Chinese version of RBDSSS (RBDSSS-C) among Chinese patients with rapid eye movement sleep behavior disorder (RBD).Methods:RBDSSS-C was ultimately formed through translation, back translation and revision according to the Brislin's translation model, including patient version (RBDSSS-PT) and bedpartner version (RBDSSS-BP). A questionnaire survey was conducted among 120 RBD patients to test the reliability and validity of the RBDSSS-C, using Cronbach’s α coefficient, Spearman-Brown coefficient, Spearman correlation analysis, content validity index and factor analysis. The correlation between RBDSSS-C and RBDQ-HK was examined.Results:For the Chinese version of RBDSSS-PT, the Cronbach’s α was 0.795, the split-half reliability was 0.756, and the test-retest reliability was 0.940. Item-level content validity indices (I-CVI) ranged from 0.833 to 1.000, and the scale-level CVI (S-CVI) was 0.937.For the Chinese version of RBDSSS-BP, the Cronbach’s α was 0.712, the split-half reliability was 0.813, and test-retest reliability was 0.950, with both I-CVI and S-CVI at 1.000.The scores of Chinese version of RBDSSS-PT and RBDSSS-BP were both significantly correlated with RBDQ-HK scores ( r=0.638, P<0.001 for RBDSSS-PT; r=0.639, P<0.001 for RBDSSS-BP). Factor analysis confirmed both single-factor structure for RBDSSS-PT and RBDSSS-BP.RBDSSS-PT showed χ2/ df=3.930, CFI=0.954, TLI=0.937, and RMSEA=0.093; RBDSSS-BP showed χ2/ df=8.300, CFI=0.975, TLI=0.966, and RMSEA=0.079. These results indicated adequate model fit. Conclusion:RBDSSS-C has good reliability and validity, and can be used as a reliable and effective tool to evaluate the severity of symptoms in Chinese RBD patients.

Objective:To sinicize the English version of the rapid eye movement sleep behavior disorder symptom severity scale (RBDSSS) and to evaluate the reliability and validity of the Chinese version of RBDSSS (RBDSSS-C) among Chinese patients with rapid eye movement sleep behavior disorder (RBD).Methods:RBDSSS-C was ultimately formed through translation, back translation and revision according to the Brislin's translation model, including patient version (RBDSSS-PT) and bedpartner version (RBDSSS-BP). A questionnaire survey was conducted among 120 RBD patients to test the reliability and validity of the RBDSSS-C, using Cronbach’s α coefficient, Spearman-Brown coefficient, Spearman correlation analysis, content validity index and factor analysis. The correlation between RBDSSS-C and RBDQ-HK was examined.Results:For the Chinese version of RBDSSS-PT, the Cronbach’s α was 0.795, the split-half reliability was 0.756, and the test-retest reliability was 0.940. Item-level content validity indices (I-CVI) ranged from 0.833 to 1.000, and the scale-level CVI (S-CVI) was 0.937.For the Chinese version of RBDSSS-BP, the Cronbach’s α was 0.712, the split-half reliability was 0.813, and test-retest reliability was 0.950, with both I-CVI and S-CVI at 1.000.The scores of Chinese version of RBDSSS-PT and RBDSSS-BP were both significantly correlated with RBDQ-HK scores ( r=0.638, P<0.001 for RBDSSS-PT; r=0.639, P<0.001 for RBDSSS-BP). Factor analysis confirmed both single-factor structure for RBDSSS-PT and RBDSSS-BP.RBDSSS-PT showed χ2/ df=3.930, CFI=0.954, TLI=0.937, and RMSEA=0.093; RBDSSS-BP showed χ2/ df=8.300, CFI=0.975, TLI=0.966, and RMSEA=0.079. These results indicated adequate model fit. Conclusion:RBDSSS-C has good reliability and validity, and can be used as a reliable and effective tool to evaluate the severity of symptoms in Chinese RBD patients.

Objective:To investigate the application value of robot-assisted parenchyma-sparing pancreatectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 54 patients who underwent robot-assisted parenchyma-sparing pancrea-tectomy in the Fujian Medical University Union Hospital from January 2017 to February 2023 were collected. There were 22 males and 32 females, aged (44±16)years. Observation indicators: (1) intraoperative conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the rank sum test. Count data were expressed as absolute numbers, and comparison between groups was performed using the Fisher exact probability. Results:(1) Intraoperative conditions. All 54 patients underwent robot-assisted parenchyma-sparing pancrea-tectomy successfully, without conversion to laparotomy. Of 54 patients, 32 cases underwent pancreatic tumor enucleation and 22 cases underwent central pancreatectomy. Of the 32 patients who underwent pancreatic tumor enucleation, 29 cases underwent conventional pancreatic tumor enucleation, and 3 cases underwent intraoperative repairing of main pancreatic duct injury. Of the 22 patients who underwent central pancreatectomy, 15 cases underwent end-to-end anastomosis, and 7 cases underwent Roux-en-Y pancreaticojejunostomy. There was no significant difference in operation time or volume of intraoperative blood loss between 29 patients undergoing conventional pancreatic tumor enucleation and 3 patients undergoing intraoperative repairing of main pancreatic duct injury ( t=-1.66, Z=-0.82, P>0.05). There were significant differences in operation time and volume of intraoperative blood loss between 15 patients undergoing end-to-end pancreatic anastomosis and 7 patients undergoing Roux-en-Y pancreaticojejunostomy ( t=-3.03, Z=-2.22, P<0.05). (2) Postoperative conditions. There were 38 of the 54 patients with postoperative complications, including 37 cases of pancreatic fistula and 1 case of delayed gastric emptying. There was no significant difference in post-operative pancreatic fistula between 29 patients undergoing conventional pancreatic tumor enuclea-tion and 3 patients undergoing intraoperative repairing of main pancreatic duct injury ( P>0.05). There was a significant difference in postoperative pancreatic fistula between 15 patients under-going end-to-end pancreatic anastomosis and 7 patients undergoing Roux-en-Y pancreaticojejunostomy ( P<0.05). (3) Follow-up. All 54 patients were followed up for 23(range, 3-76)months, and all of them survived without tumor recurrence or metastasis. None of the 32 patients undergoing enuclea-tion of pancreatic tumor experienced pancreatic endocrine or exocrine insufficiency. Of the 15 patients who underwent end-to-end pancreatic anastomosis, there were 2 cases of dilatation of the main pancreatic duct and atrophy of the distal pancreas, 1 case of pancreatic endocrine insufficiency and 1 case of exocrine insufficiency. Of the 7 patients who underwent Roux-en-Y pancreaticojejunostomy, there was 1 case of pancreatic endocrine insufficiency. Conclusion:Robot-assisted parenchyma-sparing pancreatectomy can provide intraoperative protection, repair and anastomosis of the main pancreatic duct.

Objective To investigate the correlation between TCM syndrome types and solar term of onset in patients with gastric cancer.Methods A total of 359 patients with gastric cancer admitted to the Cancer Center of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2020 to August 2023 were included in this study,and the frequency distribution method was used to analyze their information such as sex,age,solar term of onset,differentiation,metastasis and TCM syndrome type.The solar term of onset corresponding to the onset date was calculated,and then the association between solar term of onset and TCM syndrome type in gastric cancer was analyzed.The circular distribution method was used to explore the peak of solar term of onset and TCM syndrome type.Results Among the 359 patients with gastric cancer included in this study,male patients were more than female patients(1.69∶1).The age of onset was mainly between 60 and 70 years old(117 cases,32.6%),and male patients(85 cases,72.6%)were more than female patients(32 cases,27.3%)in this age group.The most common TCM syndromes were qi and blood deficiency syndrome(160 cases,44.6%)and phlegm damp condensation syndrome(94 cases,26.2%).The onset of the disease mainly occurred in winter(132 cases,36.8%),and the peaks were light snow(31 cases,23.5%),major cold(25 cases,18.9%),heavy snow(23 cases,17.4%)and the start of winter(22 cases,16.7%).Qi and blood deficiency syndrome and phlegm damp condensation syndrome in patients with gastric cancer were correlated with solar terms and seasons(P<0.05).The 285 patients with gastric cancer were mainly poorly differentiated gastric cancer(175 cases,61.4%),mainly concentrated in winter(66 cases,37.7%).The main route of gastric cancer metastasis is lymph node metastasis,followed by liver and abdominal cavity metastasis.Conclusion Qi and blood deficiency syndrome and phlegm dampness condensation syndrome are common in patients with gastric cancer.The onset time of gastric cancer is mostly in winter,and the syndrome type is significantly correlated with the onset solar term and differentiation degree.

Objective To investigate the shedding of CAV2-ΔE3-CGS after immunization and the background of canine adenovirus (CAV) infection, and to establish a dual fluorescent quantitative PCR detection method for rabies virus (RV) and canine adenovirus type 2 (CAV2). Methods A dual fluorescent quantitative PCR detection method was established by designing specific primers and probes for E1 gene of CAV and G gene of RV for the detection of CAV2-ΔE3-CGS. Oral swabs, anal swabs and environmental samples of stray dogs from experimental animal farm and dog detention center were tested. Results The standard curves generated by this method were Y=-3.351 × logX + 44.895, R² = .999 and Y=-3.413 × logX + 45.192, R²=0.996, respectively. The linear relationships were good, and the minimum detection limits were both 102 copies/μL. CAV2-ΔE3-CGS was not detected in experimental animal farm. CAV was detected in dog detention center, and the positive rates were 5.88% (5/85) in oral swabs, 8.24% (7/85) in anal swabs, and 4% (1/25) in environmental samples. Conclusion The dual fluorescent quantitative PCR method can be used for the detection of CAV2-ΔE3-CGS after immunization and the investigation of CAV infection. The present study has shown that no CAV2-ΔE3-CGS has been detected after immunization and CAV infection rate of stay dogs is low in Shanghai. CAV2-ΔE3-CGS oral immunization meets requirement and is applicable.

Objective::Annulus-sparing (AS) repair for tetralogy of Fallot (TOF) with a dysplastic pulmonary valve annulus (PVA) is a challenging procedure and is controversial. This study aimed to assess the feasibility and surgical effect of AS repair versus transannular patch enlargement (TAPE) repair, especially in individuals with dysplastic pulmonary valves.Methods::This retrospective cohort study included 375 pediatric patients with a primary diagnosis of TOF in the Center for Pediatric Cardiac Surgery of Fuwai hospital from January 2014 to June 2017. Among them, 60 consecutive and nonselective patients underwent 1-stage repair of TOF with aggressive PVA-preserving strategies performed by a single surgeon were enrolled in AS cohort. In AS cohort, patients were divided into AS, PVA z-score ≥-2 group (33 patients) and AS, PVA z-score <-2 group (27 patients). During the same period, 315 patients underwent TAPE repair by other surgeons were enrolled as TAPE cohort, of these, 87 patients with PVA z-score ≥-2 were excluded. From the 228 patients in the TAPE group, 27 cases were selected as TAPE, PVA z-score <-2 group according to the propensity score and 1:1 ratio with AS, PVA z-score <-2 group. The primary outcome was a composite of reintervention, significant pulmonary regurgitation, and significant annular peak gradient (APG). Kaplan-Meier curve was plotted to show the survival rate of severe pulmonary regurgitation.Results::One death occurred after the TAPE operation in TAPE group, and 1 patient in the AS z ≥-2 group needed reintervention with a balloon. After a median follow-up of (30.3±11.6) months, compared with AS z ≥-2 group, there was no difference in the technical performance score for severe pulmonary stenosis (APGs > 20 mmHg) in the AS z <-2 group. Compared with TAPE, AS repair was often accompanied by a postoperative APGs over 20 mmHg ( P = 0.001). More patients underwent TAPE suffered from moderate or severe pulmonary regurgitation than those who received AS repair (20 (74.1%) vs. 7 (26.0%), P < 0.001). AS repair was associated with a shorter duration of mechanical ventilation (20 vs. 29 hours, P = 0.039), faster discharge from the intensive care unit (2.0 vs. 4.0 days, P = 0.022) and shorter postoperative hospitalization (8.0 vs. 11.0 days, P = 0.008) compared with TAPE. Conclusions::APG demonstrated an upward trend in the TAPE group and a downtrend in the AS group after discharge from hospital. AS repair had an acceptable surgical effect in TOF patients, even in those with a dysplastic PVA. A higher APG remained upon hospital discharge in dysplastic patients with AS, but a downward trend was observed over time.

Objective::Annulus-sparing (AS) repair for tetralogy of Fallot (TOF) with a dysplastic pulmonary valve annulus (PVA) is a challenging procedure and is controversial. This study aimed to assess the feasibility and surgical effect of AS repair versus transannular patch enlargement (TAPE) repair, especially in individuals with dysplastic pulmonary valves.Methods::This retrospective cohort study included 375 pediatric patients with a primary diagnosis of TOF in the Center for Pediatric Cardiac Surgery of Fuwai hospital from January 2014 to June 2017. Among them, 60 consecutive and nonselective patients underwent 1-stage repair of TOF with aggressive PVA-preserving strategies performed by a single surgeon were enrolled in AS cohort. In AS cohort, patients were divided into AS, PVA z-score ≥-2 group (33 patients) and AS, PVA z-score <-2 group (27 patients). During the same period, 315 patients underwent TAPE repair by other surgeons were enrolled as TAPE cohort, of these, 87 patients with PVA z-score ≥-2 were excluded. From the 228 patients in the TAPE group, 27 cases were selected as TAPE, PVA z-score <-2 group according to the propensity score and 1:1 ratio with AS, PVA z-score <-2 group. The primary outcome was a composite of reintervention, significant pulmonary regurgitation, and significant annular peak gradient (APG). Kaplan-Meier curve was plotted to show the survival rate of severe pulmonary regurgitation.Results::One death occurred after the TAPE operation in TAPE group, and 1 patient in the AS z ≥-2 group needed reintervention with a balloon. After a median follow-up of (30.3±11.6) months, compared with AS z ≥-2 group, there was no difference in the technical performance score for severe pulmonary stenosis (APGs > 20 mmHg) in the AS z <-2 group. Compared with TAPE, AS repair was often accompanied by a postoperative APGs over 20 mmHg ( P = 0.001). More patients underwent TAPE suffered from moderate or severe pulmonary regurgitation than those who received AS repair (20 (74.1%) vs. 7 (26.0%), P < 0.001). AS repair was associated with a shorter duration of mechanical ventilation (20 vs. 29 hours, P = 0.039), faster discharge from the intensive care unit (2.0 vs. 4.0 days, P = 0.022) and shorter postoperative hospitalization (8.0 vs. 11.0 days, P = 0.008) compared with TAPE. Conclusions::APG demonstrated an upward trend in the TAPE group and a downtrend in the AS group after discharge from hospital. AS repair had an acceptable surgical effect in TOF patients, even in those with a dysplastic PVA. A higher APG remained upon hospital discharge in dysplastic patients with AS, but a downward trend was observed over time.

Objective: To compare the short-term clinical outcomes and cost differences of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). Methods: The retrospective descriptive study was adopted.The clinical data of 158 patients underwent minimally invasive distal pancreatectomy who were admitted to Fujian Medical University Union Hospital between January 2016 and July 2018 were collected.A 1∶1 matched propensity score (PSM) analysis was performed for the RDP group and the LDP group.Observed indexes included operative time, blood loss, spleen-preserving rate, postoperative hospital stay, morbidity, incidence of pancreatic fistula and hospital costs. T test or rank sum test was used to compare measurement data, χ² test or Fisher exact test was used to compare count data. Results: A well-balanced cohort of 41 patients was analyzed.There were 14 males and 27 females in the RDP group, aged (45.2±16.4)years. There were 15 males and 26 females in the LDP group, aged (47.4±14.9) years.The operation time was (209.7±52.9) minutes for the RDP group and (186.5±56.7) minutes for the LDP group (P=0.073). Median blood loss was less in RDP (50(15-175)ml) compared with LDP (100(50-350)ml) (Z=-2.689, P=0.007). Thirty-eight cases of non-malignant diseases were observed in each group and spleen-preserving rate was higher in RDP (76.3%) compared to LDP(44.7%) (χ²=7.930, P=0.005).Postoperative hospital stay was similar in the RDP group and the LDP group (RDP: 9.4 days vs. LDP: 10.6 days; P=0.372). The overall morbidity and incidence of pancreatic fistula major complication rates (RDP: 12.2% vs. LDP: 14.6%, P=0.746; RDP: 7.3% vs. LDP: 9.8%, P=1.000) were similar.Total cost of RDP group was higher than that of LDP group ((80 563.7±10 641.8) yuan vs. (57 792.8±8 943.0) yuan, t=4.515, P<0.01). Conclusions Both RDP and LDP are safe and feasible procedures. RDP is more expensive, but RDP is associated with significantly less blood loss and higher spleen-preserving rate, which is more suitable for the non-malignant diseases of pancreatic body and tail with an expectation of splenic preservation.

Objective To explore the clinical effects of laparoscopic combined with open mesh repair for abdominal wall incisional hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 41 patients with abdominal incisional hernia who were admitted to the Fujian Medical University Union Hospital between September 2011 and June 2017 were collected.All the patients underwent laparoscopic combined with open mesh repair,with the sequence from laparoscopic surgery to open surgery and then to laparoscopic surgery.Observation indicators:(1) intra-and post-operative situations;(2) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications and hernia recurrence up to November 2017.Measurement data with normal distribution were represented as (x)±s.Results (1) Intra-and post-operative situations:forty-one patients underwent successful laparoscopic combined with open mesh repair for abdominal wall incisional hernia.Diameter of hernia ring and defect area of abdominal wall were respectively (10±3)cm and (75±34)cm2.Among 41 patients,25 underwent laparoscopic combined with open mesh repair due to tight intestinal adhesion induced difficult laparoscopic separation;16 underwent laparoscopic combined with open mesh repair due to the larger diameter of the hernia ring induced difficulty of closing hernia ring under laparoscope.Operation time,cases with indwelling drainage-tube,time of drainage-tube removal and duration of postoperative hospital stay were respectively (188±71)minutes,33,(14±3)days and (4.5±2.6)days.Of 41 patients,2 with postoperative incomplete intestinal obstruction were cured by symptomatic treatment;2 with incisional infection were cured by antibiotic therapy,irrigation and dressing change.(2) Follow-up situation:41 patients were followed up for (29±17)months.The postoperative chronic pain of 2 patients was occasional and cannot affect the normal life.There was no occurrence of seroma,mesh infection,intestinal fistula,abdominal compartment syndrome and hernia recurrence during the follow-up.Conclusion The laparoscopic combined with open mesh repair has a better clinical effect for patients of incisional hernia with large hernia ring and tight intestinal adhesion,and surgical methods should be chosen seriously according to the condition of the patients in clinical application.