A 30-year-old female patient with a benign tumor in the superficial lobe of the left parotid gland underwent tumor resection via a 5 cm intra-hairline incision, using the da Vinci Xi surgical robot combined with the NIM-Response 3.0 facial nerve monitoring system. During the operation, facial nerve branches were located and protected through facial nerve monitoring, and the robotic arms were used for precise tumor dissection. Postoperatively, the facial nerve function, incision healing, and tumor recurrence were observed. duration of the procedure was 120 minutes, and the tumor（2.0 cm×1.5 cm） was completely resected. Postoperative pathological examination indicated a pleomorphic adenoma. During the 3-month postoperative follow-up, the patient's facial nerve function remained normal, no salivary fistula occurred, the incision was hidden within the hairline, no tumor recurrence was found in the ultrasound reexamination, and the patient was highly satisfied with the appearance. The surgical approach of robot-assisted resection of benign parotid gland tumor via a hairline incision under facial nerve monitoring has significant advantages in facial nerve protection and cosmetic effect, and is suitable for patients with benign parotid gland tumors meeting specific conditions.
Humans ; Female ; Adult ; Parotid Neoplasms/surgery* ; Facial Nerve ; Robotic Surgical Procedures/methods* ; Adenoma, Pleomorphic/surgery* ; Parotid Gland/surgery* ; Monitoring, Intraoperative

Objective:This article introduces a novel technique for totally laparoscopic, right thoracic approach, esophagojejunostomy for digestive tract reconstruction.Methods:A retrospective analysis was conducted on the clinical data of patients with adenocarcinoma of the esophagogastric junction who successfully underwent totally laparoscopic esophagojejunostomy via the right thoracic approach at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between February 2022 and March 2022.The surgical procedure was performed as follows:(1)Following total laparoscopic resection of the gastric tumor and lymph node dissection, the specimen was transected distal to the tumor margin. The specimen was then placed into a retrieval bag and extracted through the umbilical observation port.(2)Dissection was continued through the esophageal hiatus to mobilize the esophagus. The tumor-bearing tissue, along with the esophagus, was delivered into the thoracic cavity via the esophageal hiatus.(3)The jejunum was transected 20 cm distal to the ligament of Treitz. The distal Jejunum was mobilized for 15-20 cm and subsequently delivered into the thoracic cavity through the esophageal hiatus.(4)A Roux-en-Y jejunojejunostomy was constructed 45-50 cm distal to the cut end of the distal jejunal limb; the mesenteric defect was closed, and the duodenal stump was reinforced.(5)The patient was repositioned into the left lateral decubitus position. Port placement was established as follows: the observation port at the 7th intercostal space (ICS) in the right midaxillary line, the main operating port at the 4th ICS in the anterior axillary line, and the assistant operating port at the 9th ICS in the scapular line.(6)The main operating port incision was enlarged. Using a purse-string instrument, the esophagus was clamped and transected at least 5 cm proximal to the upper tumor margin, and the specimen was removed. (7)The distal jejunum was delivered into the thoracic cavity via the esophageal hiatus. Under total laparoscopic visualization, esophagojejunostomy was completed.Results:Both patients who underwent totally laparoscopic esophagojejunostomy via the right thoracic cavity successfully completed the procedure without conversion to laparotomy, unplanned reoperation, or any intraoperative/postoperative complications. The patients recovered well postoperatively, with no evidence of abdominal or thoracic hemorrhage. Postoperative computed tomography (CT) scans of the chest and abdomen confirmed the absence of anastomotic leakage or other related complications.Conclusions:The esophagojejunostomy was performed totally laparoscopically via the right thoracic cavity. This approach overcomes the drawback of significant trauma associated with open surgery while ensuring safe esophageal resection margins and thorough lymph node dissection. This technique offers advantages including minimal invasiveness, accelerated postoperative recovery, and a reduced incidence of reflux esophagitis. To our knowledge, no similar method of digestive tract reconstruction has been reported in the literature. Its novelty and clinical potential may offer new therapeutic options for patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG).

Objective:This article introduces a novel technique for totally laparoscopic, right thoracic approach, esophagojejunostomy for digestive tract reconstruction.Methods:A retrospective analysis was conducted on the clinical data of patients with adenocarcinoma of the esophagogastric junction who successfully underwent totally laparoscopic esophagojejunostomy via the right thoracic approach at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, between February 2022 and March 2022.The surgical procedure was performed as follows:(1)Following total laparoscopic resection of the gastric tumor and lymph node dissection, the specimen was transected distal to the tumor margin. The specimen was then placed into a retrieval bag and extracted through the umbilical observation port.(2)Dissection was continued through the esophageal hiatus to mobilize the esophagus. The tumor-bearing tissue, along with the esophagus, was delivered into the thoracic cavity via the esophageal hiatus.(3)The jejunum was transected 20 cm distal to the ligament of Treitz. The distal Jejunum was mobilized for 15-20 cm and subsequently delivered into the thoracic cavity through the esophageal hiatus.(4)A Roux-en-Y jejunojejunostomy was constructed 45-50 cm distal to the cut end of the distal jejunal limb; the mesenteric defect was closed, and the duodenal stump was reinforced.(5)The patient was repositioned into the left lateral decubitus position. Port placement was established as follows: the observation port at the 7th intercostal space (ICS) in the right midaxillary line, the main operating port at the 4th ICS in the anterior axillary line, and the assistant operating port at the 9th ICS in the scapular line.(6)The main operating port incision was enlarged. Using a purse-string instrument, the esophagus was clamped and transected at least 5 cm proximal to the upper tumor margin, and the specimen was removed. (7)The distal jejunum was delivered into the thoracic cavity via the esophageal hiatus. Under total laparoscopic visualization, esophagojejunostomy was completed.Results:Both patients who underwent totally laparoscopic esophagojejunostomy via the right thoracic cavity successfully completed the procedure without conversion to laparotomy, unplanned reoperation, or any intraoperative/postoperative complications. The patients recovered well postoperatively, with no evidence of abdominal or thoracic hemorrhage. Postoperative computed tomography (CT) scans of the chest and abdomen confirmed the absence of anastomotic leakage or other related complications.Conclusions:The esophagojejunostomy was performed totally laparoscopically via the right thoracic cavity. This approach overcomes the drawback of significant trauma associated with open surgery while ensuring safe esophageal resection margins and thorough lymph node dissection. This technique offers advantages including minimal invasiveness, accelerated postoperative recovery, and a reduced incidence of reflux esophagitis. To our knowledge, no similar method of digestive tract reconstruction has been reported in the literature. Its novelty and clinical potential may offer new therapeutic options for patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG).

Objective To investigate the effect of Elvitegravir,Cobicistat,Emtricitabine and Tenofovir Alafenamide single tablet alone versus tenofovir(TDF)+lamivudine(3TC)+efavirenz(EFV)scheme in the treatment of patients with acquired immunodeficiency syndrome(AIDS).Methods A total of 100 patients with AIDS who visited the hospital from January 2022 to October 2022 were selected and divided into two groups by random number table method,50 cases in each group.Group A was treated with Elvitegravir,Cobi-cistat,Emtricitabine and Tenofovir Alafenamide single tablet monotherapy and Group B was treated with TDF+3TC+EFV scheme.The human immunodeficiency virus(HIV)load,body immunity(CD4+,CD8+,CD4+CD38+cell ratio,CD8+CD38+cell ratio),lipid metabolism indexes[total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)],glucose metabolism indexes[fasting blood glucose(FPG),glycated hemoglobin(HbA1c)],glycoprotein 130(gp130),interleukin-35(IL-35)and its receptor IL-12Rβ2 levels were observed before and after treatment in the two groups,and the drug safety in the two groups was counted.Results After 3 months of treatment,HIV load,CD8+count,CD4+CD38+cell ratio,and CD8+CD38+cell ratio in both groups were lower than those before treatment,and CD4+count was higher than that before treatment(P＜0.05),but the difference was not statistically significant when compared between A and B groups(P＞0.05).After 3 months of treat-ment,the levels of IL-12Rβ2,gp130,IL-35,TC,TG,and LDL-C in both groups were higher than those before treatment,and HDL-C level was lower than that before treatment,and the change in group B was greater than that in group A(P＜0.05).FPG and HbAlc levels were higher in group B after 1 month and 3 months of treatment,and were higher than those in group A(P＜0.05).Drug safety analysis showed that the incidence rates of adverse reactions were 12.00％(6/50)in group A and 26.00％(13/50)in group B,and there was no statistically significant difference between the two groups(P＞0.05).The incidence rates of liver and kidney injury in group A was 10.00％(5/50),and that in group B was 12.00％(6/50),and there was no statistically significant difference between two groups(P＞0.05).Conclusion Elvitegravir,Cobicistat,Emtricitabine and Tenofovir Alafenamide single tablet monotherapy and the TDF+3TC+EFV scheme could significantly re-duce the HIV load of AIDS patients and improve their immune level,but the former has less effect on pa-tients'glycolipid metabolism and inflammatory factors,and the monotherapy scheme is superior based on the comprehensive consideration of safety and efficacy.

BACKGROUND:Most balance disorders after total hip arthroplasty require a variety of rehabilitation methods to improve.Body weight support Tai Chi footwork can be used as a safe and effective balance training method. OBJECTIVE:To observe the effect of body weight support Tai Chi footwork on the balance function of patients after total hip arthroplasty. METHODS:Totally 74 subjects undergoing total hip arthroplasty were recruited and randomly divided into a control group(n=37)and a trial group(n=37).The control group received 30 minutes of body weight support walking training and 60 minutes of routine rehabilitation training;the trial group received 30 minutes of body weight support Tai Chi footwork training and 60 minutes of routine rehabilitation training,once a day,5 times a week,for 12 consecutive weeks.Before the intervention,4,8,and 12 weeks after intervention,the Berg balance scale and the dynamic balance ability test were used to evaluate the balance function.Harris score was used to evaluate the hip joint function,and the fall risk index was used to evaluate the fall risk. RESULTS AND CONCLUSION:(1)The four observation indicators all showed significant time effects(P<0.001).(2)Berg balance scale,Harris score and fall risk index all had an interaction effect(P<0.001),and there was a significant inter-group difference after 12 weeks of intervention(P<0.001),and the effect of the trial group was better than that of the control group.(3)After 12 weeks of intervention,there was an interaction and group effect in the scores of the front and left directions of the dynamic balance test(P<0.001),and there were significant group differences in the scores of the overall,front,left and right directions(P<0.001).(4)The results showed that after 12 weeks of intervention,the balance functions of the trial group and the control group were improved,and the improvement effect of body weight support Tai Chi footwork training was better than body weight support walking training on patients after total hip arthroplasty.

Objective Based on network pharmacology and in vivo experiments,to explore the mechanism of Yangxin Decoction in treating arterial atherosclerosis.Methods In the network pharmacology part,TCMSP database is used to screen the drug active ingredients and corresponding targets of Yangxin Decoction,Gene Cards,DisGeNet,OMIM,TTD database is used to screen atherosclerosis disease targets,the Evenn platform for interactive mapping to obtain drug disease intersection targets.Cytoscape 3.7.2 software is used to build a drug active ingredient core target disease interaction network diagram,The intersection target points are imported into STRING database to obtain PPI network diagram,and the Cytascape software is used for visualization processing.The metascape v3.5 platform is used for GO and KEGG enrichment analysis,and the micro-signal platform is used for visualization processing.In vivo experiment:ApoE-/-mice established atherosclerosis animal models through high-fat diet.The model mice were randomly divided into model group(Model),low-dose Yangxin Decoction group(YXT-L),and high-dose Yangxin Decoction group(YXT-H).C57BL/6 mice were taken as the control group,YXT-L group and YXT-H group were respectively given 2.6 g·kg-1·d-1 and 5.2 g·kg-1·d-1 of Yangxin Decoction extract aqueous solution,and the control group and model group were given equal volume distilled water for 4 weeks.Oil red O staining was used to observe the plaque area of aortic sinus,and ELISA was used to detect serum IL-6 and IL-1β,Caspase-3,VEGF levels,TG,TC,LDL-C,HDL-C levels of blood lipids detected by automatic biochemical instrument,and NF-κB p65,TNF-α,IKKβ Protein expression of aorta detected by Western blot.Results Network pharmacology:105 active ingredients of Yangxin Decoction were screened out,including 535 corresponding targets,4921 atherosclerotic disease targets,162 drug disease intersection targets,and the top 10 targets include AKT1,TNF,IL-6,VEGFA,IL-1β,TP53,JUN,CASP3,PPARG,PTGS2.A total of 2224 items were obtained from and GO analysis,including 1946 biological processes,100 cell components and 178 molecular functions.A total of 216 signal pathways were obtained by KEGG signal pathway enrichment analysis,mainly involving fluid shear stress,atherosclerosis,NF-κB signaling pathway,cAMP signaling pathway,diabetes cardiomyopathy,cysteine and methionine metabolism,VEGF signaling pathway,calcium signaling pathway,etc.In vitro experiment:Yangxin Decoction reduces serum TG,TC,LDL-C in ApoE-/-atherosclerosis mice in a dose-dependent manner,increases HDL-C level,reduces aortic sinus plaque area,and reduces serum IL-6,IL-1β,Caspase-3 and VEGF level;Inhibition of aortic NF-κB p65,TNF-α,IKKβ Protein expression.Conclusion Yangxin Decoction may inhibit TNF-α/IKKβ/NF-κB signaling pathway plays an anti-atherosclerosis role by regulating lipid metabolism,inhibiting inflammatory reaction,regulating cell apoptosis,etc.

Objective To evaluate the efficacy and safety of Elvitegravir, Cobicistat, Emtricitabine and Tenofovir Alafenamide Fumarate Tablets in initial treatment of acquired immune deficiency syndrome (AIDS) patients. Methods A total of 80 treatment-naive AIDS patients were selected as research subjects and randomly divided into control group and observation group, with 40 patients in each group. The control group was treated with free antiviral drugs (tenofovir + lamivudine + efavirenz), while the observation group was treated with Elvitegravir, Cobicistat, Emtricitabine and Tenofovir Alafenamide Fumarate Tablets. The CD4⁺ count, human immunodeficiency virus (HIV) viral load, and biochemical indicators were compared between the two groups before treatment and at 3, 6, 9, and 12 months after treatment. The adherence, adverse reactions, and quality of life were also compared between the two groups. Results During the treatment, six patients in the observation group and 9 patients in the control group had no compliance. With the extension of treatment time, the CD4⁺ level in both groups gradually increased, and the HIV viral load gradually decreased (P < 0.05). After 3, 6, 9, and 12 months of treatment, the CD4⁺ levels in the observation group were higher than those in the control group, and the HIV viral loads were lower than those in the control group (P < 0.05). With the extension of treatment time, the levels of alanine aminotransferase, aspartate aminotransferase, urea, creatinine, and uric acid in the control group gradually increased, and the random blood glucose levels after 3, 6, 9, and 12 months of treatment in the control group were higher than those before treatment (P < 0.05). After 3, 6, 9, and 12 months of treatment, the levels of alanine aminotransferase, aspartate aminotransferase, urea, creatinine, uric acid, and random blood glucose in the observation group were lower than those in the control group (P < 0.05). The incidence of adverse reactions in the observation group was 2.94% (1/34), which was lower than 90.00% (36/40) in the control group (corrected χ²=55.718, P < 0.001). With the extension of treatment time, the scores of various dimensions of quality of life in both groups gradually increased, and the scores of various dimensions of quality of life after treatment in the observation group were higher than those in the control group (P < 0.05). Conclusion Compared with the free antiviral drug regimen, Elvitegravir, Cobicistat, Emtricitabine and Tenofovir Alafenamide Fumarate Tablets shows better efficacy in the treatment of AIDS-naive patients, which can significantly increase the CD4⁺ level, and reduce the HIV viral load. Besides, it has high safety, and can significantly improve their quality of life.

OBJECTIVE: To review the application of cell derived decellularized extracellular matrix (CDM) in tissue engineering. METHODS: The literature related to the application of CDM in tissue engineering was extensively reviewed and analyzed. RESULTS: CDM is a mixture of cells and their secretory products obtained by culturing cells in vitro for a period of time, and then the mixture is treated by decellularization. Compared with tissue derived decellularized extracellular matrix (TDM), CDM can screen and utilize pathogen-free autologous cells, effectively avoiding the possible shortcomings of TDM, such as immune response and limited sources. In addition, by selecting the cell source, controlling the culture conditions, and selecting the template scaffold, the composition, structure, and mechanical properties of the scaffold can be controlled to obtain the desired scaffold. CDM retains the components and microstructure of extracellular matrix and has excellent biological functions, so it has become the focus of tissue engineering scaffolds. CONCLUSION CDM is superior in the field of tissue engineering because of its outstanding adjustability, safety, and high bioactivity. With the continuous progress of technology, CDM stents suitable for clinical use are expected to continue to emerge.
Tissue Engineering/methods* ; Tissue Scaffolds/chemistry* ; Humans ; Decellularized Extracellular Matrix/chemistry* ; Cells, Cultured ; Extracellular Matrix ; Animals ; Biocompatible Materials/chemistry* ; Cell Culture Techniques

Total hip arthroplasty(THA)is an effective treatment for elderly femoral neck fractures,mid-to late-stage femoral head necrosis,and end-stage hip osteoarthritis.However,serious complications such as aseptic loosening of the prosthesis,peripheral fractures,and dislocation of the prosthesis still exist following THA,which makes the selection of the appropriate hip prosthesis type and placement position before THA an important challenge for surgeons.Currently,the commonly used preoperative planning methods for THA mainly rely on static images from two-dimensional(2D)X-ray or three-dimensional(3D)computed tomography(CT),which fail to adequately consider the hip joint in weight-bearing as well as motion,lumbar-hip joint changes,and prosthetic impingement during motion.Recently,the dual fluoroscopic imaging system,as a new in-vivo,dynamic radiological imaging technology,provides comprehensive and accurate dynamic 3D data for THA preoperative planning.However,the technical process and expert consensus on preoperative 3D planning of THA using a dual fluoroscopic imaging system have not yet been established,which affects the promotion and application of this technology.In light of the above,national orthopaedic experts and related professional representatives discussed and proposed seven consensus issues,and the'expert recommendation rate'and'strong recommendation rate'were obtained through a questionnaire survey on the recommendations of the participating experts.This consensus aims to provide guidance and reference for the standardised application of preoperative 3D planning of THA using the dual fluoroscopic imaging system.

Total hip arthroplasty(THA)is an effective treatment for elderly femoral neck fractures,mid-to late-stage femoral head necrosis,and end-stage hip osteoarthritis.However,serious complications such as aseptic loosening of the prosthesis,peripheral fractures,and dislocation of the prosthesis still exist following THA,which makes the selection of the appropriate hip prosthesis type and placement position before THA an important challenge for surgeons.Currently,the commonly used preoperative planning methods for THA mainly rely on static images from two-dimensional(2D)X-ray or three-dimensional(3D)computed tomography(CT),which fail to adequately consider the hip joint in weight-bearing as well as motion,lumbar-hip joint changes,and prosthetic impingement during motion.Recently,the dual fluoroscopic imaging system,as a new in-vivo,dynamic radiological imaging technology,provides comprehensive and accurate dynamic 3D data for THA preoperative planning.However,the technical process and expert consensus on preoperative 3D planning of THA using a dual fluoroscopic imaging system have not yet been established,which affects the promotion and application of this technology.In light of the above,national orthopaedic experts and related professional representatives discussed and proposed seven consensus issues,and the'expert recommendation rate'and'strong recommendation rate'were obtained through a questionnaire survey on the recommendations of the participating experts.This consensus aims to provide guidance and reference for the standardised application of preoperative 3D planning of THA using the dual fluoroscopic imaging system.