Objective:To investigate pertinent risk factors for postoperative pancreatic fistula(POPF) after robotic-assisted distal pancreatectomy(RDP).Methods:This is a retrospective cohort study. Clinical data of 1 211 patients who underwent various methods of distal pancreatectomy at the Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,between January 2021 and December 2023 were retrospectively collected. Among the 1 211 patients,440 cases were in the robot-assisted group(173 males and 267 females),with an age( M(IQR)) of 55(29)years;720 cases were in the open surgery group (390 males and 330 females),with an age of 64(15)years;and 51 cases were in the laparoscopic group(17 males and 34 females),with an age of 56(25)years. These 440 patients who underwent RDP were divided into two cohorts based on the presence of clinically relevant pancreatic fistulas(grades B and C). Univariate and multivariate analysis were performed on 27 factors related to POPF. Univariate analysis methods included independent sample t-test,Mann-Whitney U test,and χ 2 test,while multivariate analysis utilized binary logistic regression. Results:After stratification by pathological type,there was no significant difference in the incidence of pancreatic fistula between the robot-assisted group and the open surgery group(benign tumor: χ 2=1.200, P=0.952;malignant tumor: χ 2=0.391, P=0.532). The surgical duration of the RDP group ( Z 1=15.113, P 1<0.01; Z 2=4.232, P 2<0.01) was significantly shorter than that of the open surgery and laparoscopic groups,so as the intraoperative blood loss ( Z 1=12.530, P 1<0.01; Z 2=2.550, P 2=0.032). Postoperative hospital stay in the RDP group was significantly shorter than that in the open surgery group ( Z 1=10.947, P 1<0.01), but not different from that in the laparoscopic group ( P 2>0.05). All 440 patients underwent successful surgery,of which there was only 1 case who underwent a conversion to open surgery. A total of 104 patients(23.6%) developed clinically relevant pancreatic fistulas,and no perioperative mortality was observed. Univariate analysis revealed that 6 factors were associated with POPF after RDP: gender( χ 2=12.048, P=0.001),history of smoking ( χ 2=6.327, P=0.012),history of alcohol consumption ( χ 2=17.597, P<0.01),manual pancreas division ( χ 2=9.839, P=0.002),early elevation of amylase in drainage fluid ( Z=5.187, P<0.01),and delayed gastric emptying ( χ 2=4.485, P=0.034). No statistically significant association with POPF was found for the remaining factors(all P>0.05).The cut-off value for the early amylase level in the drainage fluid was determined to be 7 719.5 IU/ml,with an area under curve of 0.676 determined by receiver operating characteristic curve analysis. Binary logistic regression analysis identified a history of alcohol consumption( P=0.002,95% CI: 0.112 to 0.623), manual pancreas division( P=0.001,95% CI:1.446 to 4.082),early amylase level of drainage fluid ≥7 719.5 IU/ml( P<0.01,95% CI:0.151 to 0.438),and delayed gastric emptying ( P=0.020, 95% CI: 1.131 to 4.233) as independent risk factors for POPF of RDP. Conclusion:Patients with pancreatic body and tail tumors who receive RDP therapy are at increased risk of developing a pancreatic fistula if they have a history of alcohol consumption,manual pancreas division,early elevation of amylase in drainage fluid to ≥7 719.5 IU/ml, or delayed gastric emptying.

Objective:To explore the safety and efficacy of Tumai domestic multi-port robot-assisted surgery system in the clinical application of distal pancreatectomy in pancreatic tumor patients.Methods:A prospective, single-center, single-arm exploratory study was conducted. A total of 20 patients who underwent robot-assisted pancreatic body-tail resection in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from March 2023 to November 2023 were enrolled, including 13 males and 7 females, aged (57.9±11.2) years. All the patients underwent robot-assisted distal pancreatectomy with Tumai multi-port surgical robot. Clinical data of complications, intraoperative blood loss, operative time, postoperative drainage tube retention time, and postoperative pathology were collected and statistically analyzed.Results:All the 20 patients underwent surgery successfully. Only 1 patient (5.0%) was diagnosed with pancreatic neuroendocrine tumor (G1 stage), and the rest were benign pancreatic tumors, including serous cystadenoma and mucinous cystadenoma. No instrument-related organ or blood vessel injury occurred, no intraoperative complications occurred. Of 7 patients (35.0%) had postoperative complications, including 3 infections, 3 abdominal effusion, and 1 hypokalemia. According to the Clavien-Dindo grading, all the cases were grade Ⅰ except 1 case with grade Ⅱ abdominal effusion. No serious complications above grade Ⅲ occurred. The intraoperative blood loss of the 20 patients was 100(20, 200) ml, the operative time was (125.7±76.9) min, and the postoperative retention time of drainage tube was (7.9±3.4) d.Conclusion:Tumai domestic multi-port robot-assisted surgery system has acceptable safety and efficacy in the clinical application of distal pancreatectomy.

Objective:To investigate pertinent risk factors for postoperative pancreatic fistula(POPF) after robotic-assisted distal pancreatectomy(RDP).Methods:This is a retrospective cohort study. Clinical data of 1 211 patients who underwent various methods of distal pancreatectomy at the Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,between January 2021 and December 2023 were retrospectively collected. Among the 1 211 patients,440 cases were in the robot-assisted group(173 males and 267 females),with an age( M(IQR)) of 55(29)years;720 cases were in the open surgery group (390 males and 330 females),with an age of 64(15)years;and 51 cases were in the laparoscopic group(17 males and 34 females),with an age of 56(25)years. These 440 patients who underwent RDP were divided into two cohorts based on the presence of clinically relevant pancreatic fistulas(grades B and C). Univariate and multivariate analysis were performed on 27 factors related to POPF. Univariate analysis methods included independent sample t-test,Mann-Whitney U test,and χ 2 test,while multivariate analysis utilized binary logistic regression. Results:After stratification by pathological type,there was no significant difference in the incidence of pancreatic fistula between the robot-assisted group and the open surgery group(benign tumor: χ 2=1.200, P=0.952;malignant tumor: χ 2=0.391, P=0.532). The surgical duration of the RDP group ( Z 1=15.113, P 1<0.01; Z 2=4.232, P 2<0.01) was significantly shorter than that of the open surgery and laparoscopic groups,so as the intraoperative blood loss ( Z 1=12.530, P 1<0.01; Z 2=2.550, P 2=0.032). Postoperative hospital stay in the RDP group was significantly shorter than that in the open surgery group ( Z 1=10.947, P 1<0.01), but not different from that in the laparoscopic group ( P 2>0.05). All 440 patients underwent successful surgery,of which there was only 1 case who underwent a conversion to open surgery. A total of 104 patients(23.6%) developed clinically relevant pancreatic fistulas,and no perioperative mortality was observed. Univariate analysis revealed that 6 factors were associated with POPF after RDP: gender( χ 2=12.048, P=0.001),history of smoking ( χ 2=6.327, P=0.012),history of alcohol consumption ( χ 2=17.597, P<0.01),manual pancreas division ( χ 2=9.839, P=0.002),early elevation of amylase in drainage fluid ( Z=5.187, P<0.01),and delayed gastric emptying ( χ 2=4.485, P=0.034). No statistically significant association with POPF was found for the remaining factors(all P>0.05).The cut-off value for the early amylase level in the drainage fluid was determined to be 7 719.5 IU/ml,with an area under curve of 0.676 determined by receiver operating characteristic curve analysis. Binary logistic regression analysis identified a history of alcohol consumption( P=0.002,95% CI: 0.112 to 0.623), manual pancreas division( P=0.001,95% CI:1.446 to 4.082),early amylase level of drainage fluid ≥7 719.5 IU/ml( P<0.01,95% CI:0.151 to 0.438),and delayed gastric emptying ( P=0.020, 95% CI: 1.131 to 4.233) as independent risk factors for POPF of RDP. Conclusion:Patients with pancreatic body and tail tumors who receive RDP therapy are at increased risk of developing a pancreatic fistula if they have a history of alcohol consumption,manual pancreas division,early elevation of amylase in drainage fluid to ≥7 719.5 IU/ml, or delayed gastric emptying.

Background In view of circulatory diseases, most previous studies focused on the impacts of air pollution and meteorological factors, while ignoring the influence of built environment. Objective To investigate and quantify the impact of built environment on circulatory diseases in China. Methods Circulatory disease mortality data and built environment data (including urban greenery coverage, urban land use, urban land use mix, urban road facilities and urban medical facilities) of 17 cities in China from 2000 to 2019 were collected. Multiple linear regression was used to analyze which built environment elements had significant influence on circulatory diseases, and to quantify their effects. Furthermore, the changes of built environment indicators on circulatory disease mortality were evaluated under different levels of urban economic development and various air quality. Results The built environment affected the mortality of circulatory diseases during the study period (P<0.05). Urban green space and commercial land area were negatively correlated with circulatory disease mortality, and regression coefficients were −0.550 and −0.280, respectively (P<0.05). On the contrary, the increase of urban road area, residential land ratio, and the degree of land use mix were positively associated with circulatory disease mortality, and their regression coefficients were 0.322, 0.283, and 0.176, respectively (P<0.05). When the level of urban economic development was low, the impact of commercial land use ratio on circulatory diseases was stronger, and the regression coefficient was −0.476 (P<0.05). When urban air pollution worsened, the impacts of per capita green coverage area and per capita urban road area on the disease were more prominent, and the regression coefficients were −0.528 and 0.372, respectively (P<0.05). Conclusion There is a significant correlation between urban built environment and mortality of circulatory diseases. To be specific, circulatory disease mortality has a negative correlation with per capita green coverage area and commercial land use ratio, and a positive correlation with per capita urban road area, residential land ratio and degree of land use mix.

Objective:To investigate the prognosis of robotic pancreatoduodenectomy after the learning curve and open pancreatoduodenectomy for pancreatic cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 396 patients who underwent curative pancreatoduodenectomy for pancreatic duct adenocar-cinoma in Ruijin Hospital of Shanghai Jiaotong University School of Medicine from January 2017 to December 2018 were collected. There were 244 males and 152 females, aged 64(range, 36?92)years. Of 396 patients, 86 cases undergoing robotic pancreatoduodenectomy were divided into robotic group, 310 cases undergoing open pancreatoduodenectomy were divided into open group. Observa-tion indicators: (1) propensity score matching and comparison of general data between the two groups after matching; (2) follow-up and survival analysis. Follow-up was conducted by telephone interview or outpatient examinations including tumor markers and abdominal imaging examina-tions to detect survival of patients up to March 2022. Overall survival was defined as the time from the surgery date to death or the last follow-up. Disease-free survival was defined as the time from the surgery date to tumor recurrence or the last follow-up. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Normality of measurement data was examined using the Shapiro-Wilk test. Measurement data with skewed distribution were described as M(range), and comparison between groups was analyzed using the Mann-Whitney rank-sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-Rank test was used for survival analysis. An intent-to-treat analysis was performed in this study, patients who were converted to laparotomy from robotic surgery were still divided into the robotic group. Results:(1) Propensity score matching and comparison of general data between the two groups after matching: 164 of 396 patients had successful matching, including 82 cases in robotic group and open group, respectively. Before propensity score matching, the body mass index, cases in stage T1, T2, T3, T4, cases in N0, N1, N2 were 23.4(range, 21.4?25.3)kg/m 2,24, 41, 10, 11, 52, 27, 7 for the robotic group, versus 22.4(range,20.3?23.9)kg/m 2,57, 144, 22, 87, 131, 132, 47 for the open group, showing significant differences in the above indicators between the two groups ( Z=3.01, 2.63, 3.03, P<0.05). After propensity score matching, cases of males, age, body mass index, cases with American Society of Anesthesiologists (ASA) score as 1, 2, 3, CA19-9, cases with preoperative biliary drainage, cases with portal vein resection, cases with pancreatic resection margin <1 mm, cases in stage T1, T2, T3, T4, cases in stage N0, N1, N2, cases with nerve invasion, cases with tumor differentiation as high-medium differentiation, medium-low differentiation, low differentiation, cases with adjuvant chemotherapy were 51, 65(range, 59?69)years, 23.0(range, 21.0?25.2)kg/m 2, 32, 41, 9, 160.4(range, 46.7?377.2)U/mL, 21, 9, 8, 21, 40, 10, 11, 48, 27, 7, 76, 26, 47, 9, 53 for the robotic group, versus 58, 65(range, 58?69)years, 23.3(range, 21.4?25.3)kg/m 2, 35, 39, 8, 172.0(range, 69.7?402.9)U/mL, 26, 9, 10, 24, 40, 7, 11, 49, 28, 5, 76, 22, 49, 11, 57 for the open group, showing no significant difference in the above indicators between the two groups ( χ2=1.34, Z=0.18, 0.34, 0.49, 0.51, χ2=0.75, 0.00,0.25, Z=0.59, 0.27, χ2=0.00, Z=0.76, χ2=0.44, P>0.05). (2) Follow-up and survival analysis: after propensity score matching, 164 patients were followed up for 54(range, 1?67)months. The follow-up time of patients was 55(range, 51?59)months for the robotic group, versus 54(range, 50?58)months for the open group, respectively, showing no significant difference between the two groups ( Z=0.48, P>0.05). During the follow-up, the 1-year overall survival rate, 3-year overall survival rate, the median survival time, 1-year disease-free survival rate, 3-year disease-free survival rate, the median disease-free survival time, tumor recurrence rate, cases with recurrence pattern as local recurrence, liver recurrence, other distant recurrence, local and distant recurrence were 81.7%, 39.0%, 27 months(95% confidence interval as 19?33 months), 61.0%, 34.2%, 15 months(95% confidence interval as 12?18 months), 54.9%(45/82), 12, 16, 9, 8 for the robotic group. The above indicators were 79.3%, 36.0%, 24 months(95% confidence interval as 19?31 months), 59.8%, 27.5%, 15 months(95% confidence interval as 10?20 months), 58.5% (48/82), 10, 22, 6, 10 for the open group. There was no significant difference in overall survival or disease-free survival between the two groups ( χ2=0.39, 0.47, P>0.05). There was no significant difference in tumor recurrence rate or tumor recurrence site between the two groups either ( χ2=0.22, 1.86, P>0.05). Conclusion:After the learning curve, robotic pancreato-duodenectomy has non-inferior prognosis compared with open pancreatoduodenectomy.

Objective:To explore the treatment efficacy of neuroendoscope-assisted exploration and release of the outflow tract of the fourth ventricle in patients with Chiari malformation type I.Methods:Ninety-five patients with Chiari malformation type I, admitted to our hospital from January 2016 to January 2020, were chosen in our study. Patients from observation group ( n=57) were treated with posterior cranial fossa decompression+subdural tonsillectomy+endoscope-assisted exploration and release of the outflow tract of the fourth ventricle+enlarged reconstruction of the occipital cistern. Patients from control group ( n=38) were treated with posterior fossa decompression+subdural tonsillectomy+enlarged reconstruction of the occipital cistern. All patients were followed up for one year. Data of surgical duration, intraoperative blood loss, postoperative length of hospital stay, and incidence of complications were retrospectively analyzed in patients from the two groups, and the imaging changes of spinal cavity were observed before surgery and during postoperative follow-up. Chicago Chiari Outcome Scale (CCOS) was used to evaluate the prognoses of all patients (scores of 11-16 were defined as good prognosis). The differences of good prognosis rate among patients with different gender, age, degrees of tonsillar herniation and distributions of spinal cavity segments were analyzed. Results:There was no significant difference in surgical duration, intraoperative blood loss, postoperative length of hospital stay or incidence of complications between the two groups ( P>0.05). As compared with the control group (65.5%), the observation group had higher syringomyelia minification (75.5%) during postoperative follow-up, without significant difference ( P>0.05). The good prognosis rate of the observation group during postoperative follow-up (91.2%) was significantly higher than that of the control group (78.9%, P<0.05). Female patients, patients with age≤45 years, and patients with tonsillar herniation level below the atlas had significantly higher good prognosis rate than male patients, patients with age>45 years, and patients with tonsillar herniation level between the foramen magnum and the atlas during postoperative follow-up, respectively ( P<0.05). Conclusion:As compared with conventional surgery, neuroendoscope-assisted exploration and release of the outflow tract of the fourth ventricle is more effective in patients with Chiari malformation type I, and the good prognosis rate is likely higher in female patients, patients with age≤45 years, and patients with tonsillar herniation level below the atlas.

Objective:To investigate the application value of different types of acellular matrix graft biological meshes in inguinal hernia repair of adolescents.Methods:The retrospective cohort study was conducted. The clinical data of 159 adolescent patients with inguinal hernia who were admitted to Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2013 to June 2018 were collected. There were 155 males and 4 females, aged from 13.0 to 18.0 years, with a median age of 15.0 years. Of the 159 patients, 42 undergoing traditional high ligation of hernia sac were divided into traditional operation group, 61 undergoing Lichtenstein hernia repair using domestic cross-linked acellular matrix graft biological meshes were divided into domestic biological mesh group, and 56 undergoing Lichtenstein hernia repair using imported non cross-linked acellular matrix graft biological meshes were divided into imported biological mesh group. Observation indicators: (1) surgical situations; (2) postoperative recovery; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detected postoperative recovery and complications of patients up to June 2019. Measurement data with skewed distribution were represented as M (range), comparison between multiple groups was analyzed using the Kruskal-Wallis H test, and paired comparison between groups was analyzed using the Nemenyi test. Count data were described as absolute numbers, comparison between multiple groups was analyzed using the chi-square test or Fisher exact probability, and paired comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison between groups was corrected using the Bonferroni method. Results:(1) Surgical situations: all the 3 groups underwent inguinal hernia repair successfully. The operation time of the traditional operation group, domestic biological mesh group and imported biological mesh group was 20 minutes(range, 10-25 minutes), 35 minutes (range, 30-40 minutes) and 35 minutes (range, 30-40 minutes), respectively, showing a significant difference among the three groups ( χ2=91.640, P<0.05). There were significant differences in the operation time between the traditional operation group and the domestic biological mesh group or between the traditional operation group and the imported biological mesh group ( P<0.016 7). There was no significant difference in the operation time between the domestic biological mesh group and the imported biological mesh group( P>0.05). (2) Postoperative recovery: the postoperative recurrence rate of hernia of the traditional operation group, domestic biological mesh group and imported biological mesh group was 7.1%(3/42), 0, 0, respectively, showing a significant difference among the three groups ( χ2=8.150, P<0.05). There were significant differences in the postoperative recurrence rate of hernia between the traditional operation group and the domestic biological mesh group or between the traditional operation group and the imported biological mesh group ( P<0.016 7). There was no significant difference in the postoperative recurrence rate of hernia between the domestic biological mesh group and the imported biological mesh group( P>0.05). The incidence of seroma of the traditional operation group, domestic biological mesh group and imported biological mesh group was 0, 3.3%(2/61), 17.9%(10/56), respectively, showing a significant difference among the three groups ( χ2=14.929, P<0.05). There were significant differences in the incidence of seroma between the imported biological mesh group and the traditional operation group or between the imported biological mesh group and the domestic biological mesh group ( χ2=6.517, 6.741, P<0.016 7). There was no significant difference in the incidence of seroma between the traditional operation group and the domestic biological mesh group ( P>0.05). The incidence of fat liquefaction of incision of the traditional operation group, domestic biological mesh group and imported biological mesh group was 0, 3.3%(2/61), 1.8%(1/56), respectively, showing no significant difference among the three groups ( P>0.05). Patients with fat liquefaction of incision were cured after the treatment of dressing change. The duration of hospital stay of the traditional operation group, domestic biological mesh group and imported biological mesh group were 3.0 days(range, 2.0-5.0 days), 3.0 days(range, 1.0-5.0 days), 2.5 days(range, 1.0-5.0 days), respectively, showing no significant difference among the three groups ( χ2=0.907, P>0.05). (3) Follow-up: all the 155 patients were followed up for 12-77 months, with a median time of 41 months. None of patients was observed with chronic pain, foreign body sensation or infection during the follow-up. Conclusions:It is safe and effective to repair adolescent inguinal hernia with biological mesh. There was no significant difference in the clinical efficacy between the two different types of acellular matrix graft biological meshes, both of which can be used in repair of adolescent inguinal hernia.

Objective To investigate the expression and signaling pathway of TAGLN2 gene in low-grade glioma (LGG),and the relation of its expression with prognoses of patients.Methods The expression of TAGLN2 gene in Oncomine and TCGA databases was analyzed by bioinformatics analysis.The TAGLN2-related protein-protein interaction network was mapped using STRING database,and the interacting protein coding genes involved in the network were enriched.According to the expression level of TAGLN2 gene in glioma,the patients were divided into high expression group and low expression group;the differences of overall survival (OS) and disease free survival (DFS) were compared between the two groups.Results The expression level of TAGLN2 gene was up-regulated in most of the tumors.The expression level of TAGLN2 gene in the tumors of LGG patients was obviously higher than that in the corresponding normal brain tissues.The missense mutation of TA GLN2 gene was analyzed in TCGA database,and 1.5％ of TAGLN2 gene missense mutation occurred in glioma tissues.There were 51 nodes in TAGLN2-related protein-protein interaction network and 254 interaction relations,and the regional clustering index was 0.69.The network protein enrichment was obvious (P=1.0E-16).The proteins encoding and interacting with TAGLN2 gene were mainly concentrated in vesicles,extracellular matrix and cell membrane.Their molecular functions were mainly protein binding,iron binding and accounting binding;their biological processes were mainly concentrated in the regulation of biological functions,cell development and multicellular tissue processes.OS and DFS of TAGLN2 high expression group were significantly lower than those of low expression group (HR=2.7,HR=1.8,P＜0.05).Analysis of LGG cell subtypes showed that OS and DFS of astrocytoma in TA GLN2 high expression group were lower than those in low expression group (P＜0.05).The OS of oligodendroglioma in the TA GLN2 high expression group was significantly lower than that in the low expression group (P＜0.05).There were no significant differences in OS and DFS of oligodendrocytoma and DFS of oligodendroglioma between the TAGLN2 high and low expression groups (P＞0.05).Conclusion TAGLN2 is highly expressed in LGG tissues and is associated with poor prognosis.

Objective: To compare the surgical accuracy of the 3D printing surgical guide and traditional occlusal splint in the treatment of skeletal facial asymmetry cases. Methods: 12 facial asymmetric patients underwent joint orthognathic and orthodontics treatments were included in this research. In the 3D printing group (n=6) the pre-surgical CT scan for the skeleton and laser scan for the dentures were performed and 3D orthognathic procedures including Le FortⅠ and BSSRO combined with genioplasty were planned. The 3D printing surgical guides were manufactured and applied during surgeries. Another 6 cases were received same procedures by traditional occlusal splint techniques as the control group. Post-surgical CT reconstruction and 3D superimposition with pre-surgical planning was carried out for outcome comparison. Results: The maximal error of maxillar was 0.65 mm and average error was less than 1 mm in 3D printing group, while the maxillary maximal error was 2.11 mm and average error was greater than 1 mm in traditional group which showed the statistical significance (P<0.05). Conclusions The usage of 3D printing surgical guide could improve the orthognathic surgical precision by controlling the jaw bone in a three-dimensional way.

With the continuous improvement of the diagnosis rate of benign pancreatic disease and the younger age of disease onset,the demand for minimally invasive pancreatic surgery is increasing,meanwhile,how to keep the normal pancreatic tissue as much as possible to reduce the impact on the patients' life has gained surgeons' thinking.The Da Vinci robotic surgical system,providing a clearer 3D vision and more accurate operation,makes some difficult minimally invasive pancreatic surgery such as pancreaticoduodenectomy can be carried out extensively.Based on clinical experiences and related literatures,this paper will analyze the present situation of Da Vinci robot-assisted pancreatic surgery and give prospects.