Objective:To investigate the application value of biological muscle flap in laparo-scopic radical proximal gastrectomy with esophagogastric anastomosis.Methods:The retrospec-tive and descriptive study was conducted. The clinicopathological data of 10 patients with adeno-carcinoma of esophagogastric junction who were admitted to The First Affiliated Hospital of Xi′an Jiaotong University from May 2023 to August 2023 were collected. All patients were males, aged (65±5)years. All patients underwent laparoscopic radical proximal gastrectomy and esophagogastric anastomosis with digestive tract reconstruction using the esophagogastric biological muscle flap. Observation indicators: (1) surgical situations and early complications; (2) follow-up and late com-plications. Measurement data with normal distribution were represented as Mean± SD, and measure-ment data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations and early complications. All 10 patients success-fully completed the surgery without conversion to open surgery, and the operation time was (166±18)minutes. Cases with digestive tract reconstruction as end-to-side anastomosis and Overlap anas-tomosis were 1 and 9, respectively. The time of digestive tract reconstruction, the number of lymph node dissected, volume of intraoperative blood loss, time to postoperative first anal exhaust, time to postoperative first intake of liquid food, duration of postoperative hospital stay were (40±12)minutes, 24±6, (41±9)mL, (3.4±0.5)days, (4.1±1.0)days, (8.3±0.7)days in the 10 patients. Of 4 cases with postoperative early complications, 1 case developed pulmonary infection (Clavien-Dindo grade Ⅱ) on the second day after surgery, with pulmonary infection absorbed after 5 days of antibiotic treat-ment. Two cases experienced chest distress and shortness of breath on the third day after surgery, with the diagnosis of a small to moderate amount of pleural effusion after chest B-ultrasound examination. After pleural puncture and active treatment, the symptoms of them were improved and the pleural effusion disappeared. There was 1 case with choking sensation when eating solid food, which was started from the third week after surgery. Upper gastrointestinal imaging revealed mild anastomotic stenosis of Clavien-Dindo grade Ⅰ in the patient, who was improved after conservative treatment. On the 7th day after surgery, all 10 patients underwent upper gastrointestinal angiography, and no anastomotic leakage or stenosis occurred. There was no sign of contrast agent reflux in the supine position and 30° head down position. (2) Follow-up and late complications. All 10 patients were followed up for 59.5(range, 31.0-127.0)days. The esophageal reflux scale score of 10 patients was 1.4±0.3. During the follow-up, 1 case underwent gastroscopy on 40 days after surgery, which showed reflux esophagitis with Los Angeles grade as B and the Clavien-Dindo grade as Ⅰ. There was no clinical symptom such as heartburn or acid reflux. Results of 24-hour pH monitoring showed that the patient experienced 24 instances of reflux in an upright position and 15 instances of reflux in a supine position, with no prolonged reflux. The total reflux time within 24 hours was 75 minutes. The DeMeester score was 38.3. Results of esophageal pressure measurement showed that the esophageal contraction morphology was normal, but the anastomotic opening was not well relaxed. The rest of 9 cases had no complication such as reflux esophagitis.Conclusion:Biological muscle flap applied in the laparoscopic radical proximal gastrectomy with esophagogastric anastomosis is safe and feasible, with satisfied short-term efficacy.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

【Objective】 To systematically evaluate the incidence of donation related vasovagal reactions (DRVR) in China by Meta-analysis method and discuss the risk factors of DRVR, so as to provide scientific basis for the prevention and control of DRVR. 【Methods】 Cochrane Library, PubMed, WanFang Data CNKI and other electronic databases were retrieved to collect research literature concerning the incidence and risk factors of DRVR among whole blood donors in mainland China, with the publishing duration setting from 1998 to 2020. Two reviewers independently screened the literature, extracted the data, and evaluated the methodological quality of the included studies according to the inclusion and exclusion criteria. Then Stata was used for Meta-analysis. 【Results】 A total of 63 studies involving 6 043 945 donors were included. The prevalence of DRVR was 1.0% (95% confidence interval [CI], 0.9%~1.1%, I²=99.7%, P<0.01). The prevalence of DRVR in females (1.4%, 95% CI: 1.0-1.8%, I²=99.6%, P<0.01) was higher than that in males (1.1%, 95 % CI: 0.8-1.4%, I²=99.6%, P<0.01). The incidence of DRVR was 1.3% (95%CI: 0.8-1.8, I²=97.9%, P<0.01), 0.8% (95%CI: 0.5-1.0, I²=95.0%, P<0.01), 0.4% (95%CI: 0.3-0.5, I²=88.5%, P<0.01) and 0.3% (95%CI: 0.1-0.6, I²=96.1%, P<0.01) in the age groups of 18-25, 26-35, 36-45 and 46-55, respectively, and the incidence of DRVR decreased with age(P<0.01). From 1998 to 2020, the incidence of DRVR decreased year by year (P<0.01). The prevalence in first-time donors (1.5%, 95% CI: 1.3-1.8, I²=98.6%, P<0.01) was higher than that of regular donors (0.6%, 95% CI: 0.5-0.7%, I²=97.2%, P<0.01). Anxiety was the major risk factor for DRVR. 【Conclusion】 Our results indicate that blood centers should strengthen the monitoring of DRVR. More attention should be paid to young women, more comfort given to first-time blood donors, and a more perfect system developed to reduce the occurrence of DRVR.

Ureteral artery fistula (UAF) is a rare complication after long-term indwelling of ureteral stent. In this study, two cases were presented. Both of them underwent pelvic tumor surgery and radiotherapy, and had a history of cutaneous terminal ureterostomy and long-term indwelling of ureteral stents. The first case, a 52-year-old female, was admitted to hospital because of intermittent bleeding from ureteral dermostomy for 1 week on April 2, 2020. CT examination revealed hematocele in the left upper urinary tract, and left nephrectomy was performed.However, bleeding still presented and the distal ureteral resection was performed at the same time, and partial ureteral was ligated. Postoperative diagnostic was ureteral artery fistula. After 8 months of follow-up, no recurrent bleeding presented. Another case, a 82-year-old male, was admitted to hospital because of bleeding at the ureteral dermostomy for an hour on June 15, 2020. Contrast enhanced CT examination revealed intersecting of the left ureter and common iliac artery, and interventional surgery was performed, by which UAF was diagnosed. Embolization of left internal iliac artery and stent implantation of common iliac artery and external iliac artery were performed intraoperatively. The bleeding stopped immediately after the operation, and there was no further bleeding during follow-up of 6 months.

Objective To evaluate the efficacy of incision infiltration with ropivacaine in improving routine analgesia after laparoscopic cholecystectomy.Methods A total of 140 patients,aged 18-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy under general anesthesia,were enrolled and randomly assigned to ropivacaine group (group R)and routine analgesia group (group C).Three-port laparoscopic procedure was carried out.Before inserting trocars,incision infiltration was performed with ropivacaine with a total volume of 16 ml,6 ml for epigastric port,6 ml for umbilical port and 4 ml for working port.The equal volume of normal saline was given instead of ropivacaine in group C.Parecoxib 40 mg was intravenously injected before surgery in both groups or after surgery as rescue analgesic when necessary.The requirement for rescue analgesia was recorded within 24 and 48 h after surgery.The visual analogue scale (VAS) scores at rest and during activity were recorded at 2,4,6,8,12,18,24 and 48 h after surgery,and the area under curve (AUC) of VAS scores was calculated in each time point after surgery.The development of no pain at rest was recorded at 24 h after surgery.Parents'satisfaction with analgesia was assessed and scored at 24 and 48 h after surgery.Wound healing was evaluated and scored at 48 h after surgery,and the development of poor wound healing was recorded.The development of chronic pain and VAS scores were recorded at day 90 after surgery.Results There were 130 patients who completed the study,with 66 cases in group R and 64 cases in group C.Compared with group C,the AUC of VAS scores at rest in 0-8 h and 0-24 h periods after surgery was significantly decreased,the AUC of VAS scores at rest in 0-6 h,0-8 h,0-12 h,0-24 and 0-48 h periods after surgery was decreased,the requirement for rescue analgesia was reduced at 24 h after surgery,satisfaction scores were increased (P＜0.05),and no significant change was found in the rate of no pain at rest after surgery,wound healing score,incidence of poor wound healing,incidence of chronic pain at day 90 after surgery or VAS score at day 90 after surgery in group R (P＞0.05).Conclusion Incision infiltration with ropivacaine before incision can effectively alleviate acute pain within 48 h after laparoscopic cholecystectomy with a higher safety and exerts no effect on chronic pain after surgery.

Objective To investigate the incidence of genotypes related to analgesia and muscle relax effects,and to review the genetic polymorphism of OPRM1,CYP3A4 * 1G,SLCO1B1 and ABCB1 in Han population in North-western China.Methods The genotypes of OPRM1,CYP3A4 * 1G,SLCO1B1 and ABCB1 in patients born in North-western China between September,2016 and May,2017 were reviewed.North-western China was defined as Shaanxi,Gansu,Ningxia,Qinghai and Xinjiang Provinces.The distribution of genotypes was recorded.And the differences between male and female patients were compared.Results The frequency was 42.11％ for AG genotype and 12.14％ for GG genotype of OPRM1 (118A＞G).For CYP3A4 * 1G,the frequencies of CC,TT,TC and CT were 29.69％,4.17％,65.67％ and 0.47％,respectively.For ABCB1,the frequencies of CC,TT,TC and CT were 13.07％,44.60％,0.28％ and 42.05％,respectivsly.For SLCO1B1,AG genotype appeared in 37.44 ％ of the patients,GG genotype appeared in 55.21％ of the patients.There was no difference between the male and the female patients.Conclusion Genotypes related to change of susceptibility to opioids including fentanyl and rocuronium were detected in high percentage of patients in North-western China,indicating that SNP assay for instruction of anesthetic practice be of value.

Objective To develop a machine simultaneously integrating mechanized environmental cleaning and automatic mollusciciding and to evaluate its effectiveness of field application,so as to provide a novel Oncomelania hupensis snail control technique in the large?scale marshlands. Methods The machine simultaneously integrating mechanized environmental clean?ing and automatic mollusciciding,which was suitable for use in complex marshland areas,was developed according to the mech?anization and automation principles,and was used for O. hupensis snail control in the marshland. The effect of the machine on environmental cleaning and plough was evaluated,and the distribution of living snails was observed at various soil layers follow? ing plough. The snail control effects of plough alone and plough followed by mollusciciding were compared. Results The ma?chine could simultaneously complete the procedures of getting vegetation down and cut vegetation into pieces,plough and snail control by spraying niclosamide. After plough,the constituent ratios of living snails were 36.31% ,25.60% ,22.62% and 15.48% in the soil layers at depths of 0-5,6-10,11-15 cm and 16-20 cm respectively,and 61.91% living snails were found in the 0-10 cm soil layers. Seven and fifteen days after the experiment,the mortality rates of snails were 9.38% and 8.29% in the plough alone group,and 63.04% and 80.70% in the plough + mollusciciding group respectively(c27 d = 42.74,c215 d =155.56,both P values < 0.01). Thirty days after the experiment,the densities of snails were 3.02 snails/0.1 m2 and 0.53 snails/0.1 m2 in the soil surface of the plough alone group and the plough + mollusciciding group,which decreased by 64.92% and 93.60% ,respectively,and the decrease rate of snail density was approximately 30% higher in the plough + mollusciciding group than that in the plough alone group. Conclusions The machine simultaneously integrating mechanized environmental cleaning and automatic mollusciciding achieves the integration of mechanical environmental cleaning and automatic niclosamide spraying in the complex marshland areas,which provides a novel technique of field snail control in the large?scale setting in Chi?na.

Objective To observe the influence of Huiyang Shengji Ointment and its modified formulae on interleukin-1 (IL-1α) and thromboxane B2 (TXB2) in diabetic rats with chronic skin ulcers, and explore the mechanism for promoting the healing of ulcer.Methods Six out of 160 rats were randomly selected as a blank group, without any further processing. The remaining rats were made diabetic model and randomly divided into five groups after 2 weeks:1 d, 3 d, 5 d, 7 d and 14 d groups. Then, these groups were further divided into normal group (Vaseline ointments), model group (Vaseline ointments), Huiyang Shengji Ointment group (whole formula Ointment), Wenyang Yiqi group (Yiqi group, modified Wenyang Yiqi formula ointments) and Huoxue Shengji group (Huoxue group, modified Huoxue Shengji formula ointments). Normal group and model group were given Vaseline ointments;whole formula group, Yiqi group and Huoxue group were given corresponding ointment. Normal group used the method of skin excision, while other groups used STZ injection-hydrocortisone interference-skin excision-foreign body embedded preparation of composite factors for chronic skin ulcer model. After the appropriate treatment period, the rats were executed and tested for the contents of IL-1α and TXB2 in serum by enzyme-linked immunosorbent assay of five time points.Results In treatment 3 d, the contents of IL-1α in Yiqi group were significantly higher than the blank group, model group, whole formula group and Huoxue group (P<0.05). In treatment 5 d, the contents of IL-1α in whole formula group were significantly higher than the blank group and model group (P<0.05). In treatment 7 d, the contents of IL-1α in each treatment group were significantly higher than blank group and model group (P<0.05), and the whole formula group was higher than the Yiqi group and Huoxue group. In treatment 14 d, the contents of IL-1α in model group and Huoxue group were lower than the blank group (P<0.05). In treatment 3 d, the contents of TXB2 in normal group and the whole formula group were higher than the blank group (P<0.05). In treatment 5 d, the contents of TXB2 in whole formula group were higher than the blank group and the normal group (P<0.05). In treatment 7 d, the contents of TXB2 in Yiqi group were higher than the blank, the model, the whole formula and Huoxue groups (P<0.05). In treatment 14 d, the contents of TXB2 in Huoxue group were higher than the blank and model group (P<0.05), and the contents of TXB2 in the blank group and normal group was lower than those treatment groups (P<0.05).Conclusion Huiyang Shengji Ointment and its modified formulae could promote inflammation, stimulate secretion of inflammatory cytokines, while Yiqi Wenyang ointments played a more active role in promoting inflammation of the early phase of wound surface.

Objective To observe the effects of berberine on ICAM-1, VCAM-1 expression and inflammatory cells exudation in mice with viral pneumonia caused by influenza virus, and explore its anti-injury effect. Methods Totally 108 BALB/c mice were randomly divided into control group, model group, and berberine group. 25 μL 50 LD50 influenza virus, mouse lung-adapted strain, was intranasally inoculated to model group and berberine group. 1 h after infection, control and model group were intragastrically given 25 μL distilled water, berberine group was treated by intraperitoneal injection with berberine at a dose of 0.005 g/(kg·d) for 5 days, twice per day. On day 2, 4 and 6 after infection, immunocytochemical method was used to detect ICAM-1 and VCAM-1 expression, and sorting cell count of leukocytes in bronchoalveolar lavage fluid (BALF) were counted. Results The expression of ICAM-1 and VCAM-1 in model group increased obviously on day 2, 4, 6, and which in berberine group decreased compared with model group (P<0.01). WBC, mononuclear cell, eosinophile cell and neutrophil cell number in model group increased significantly. WBC and neutrophil cell number decreased in berberine group on day 6 (P<0.01), and the mononuclear cell number decreased on day 4 (P<0.01). Conclusion Berberine inhibited the expression of ICAM-1 and VCAM-1, and decreased the inflammatory cells exudation in lung of mice with viral pneumonia caused by influenza virus. Berberine has protective effect on inflammatory injury of lung tissue in mice with viral pneumonia caused by influenza virus.

BACKGROUND: With conversion of medical patterns and revolution of healthy concept, temperament, psychological health and behavior become key topics for child care and are paid more and more attention nowadays.OBJECTIVE: To survey the status quo of psychological and behavior problems and distribution of temperamental types through questionnaire for children in Guiyang.DESIGN: Randomized cluster sampling and cross-sectional study.SETTING: Guiyang Institute for Mother and Child Health.PARTICIPANTS: Twelve settings were randomly selected from 33 duty units for child care in Guiyang. Children aged 1-6 years suffered from health check at survey stage, and those with severe body diseases and abnormal intelligence were excluded.METHODS: Problems of psychological health and behavior and distribution of temperamental types for children were surveyed with self-made psychological health scale, Chinese temperament scale for 1-3-year children,Chinese temperament scale for 3-7-year children, behavior scale for 2-3-year children and Achenbach's children behavior scale standardized by Shanghai Mental Health Center. All questionnaires were answered by parents and taken back on the spot. After 2-4 weeks, several children were randomly selected to refill in the questionnaires mentioned above to measure reliability again.MAIN OUTCOME MEASURES: Status quo of psychological and behavior problems, distribution of temperamental types and effect of social environment on temperament and behavior.RESULTS: ① Distribution of temperamental types was divided into easy nurture, difficult nurture, nearly easy nurture, nearly difficult nurture and slow development, and the percentage was 35.58%, 4.21%, 39.70%, 7.37%and 13.14%. ② Total ratio of psychological problems was 94.50%, and ratios of children in various temperamental types were 98.91%, 97.26%,96.19%, 94.05% and 93.13% (P ＜ 0.01). ③ Total ratio of behavior problems was 19.57%, and ratios of children in various temperamental types were 31.76%, 26.69%, 22.58%, 21.33% and 12.72% (P ＜ 0.01). Temperamental types and behavior problems were related to living condition, educational level of parents, marriage, supervised attitude, paternity, pregnant nutrien, illness and infirmarian, especially temperament was closely related with psychological and behavior problems.CONCLUSION: Psychological and behavior problems wildly exist among children in Guiyang and should be paid much attention. Fine personality of children can be molded through reforming relevant factors so as to decrease the incidence of psychological and behavior problems.