Objective:To investigate the short-term outcomes of robot-assisted pancreato-duodenectomy (RPD) performed by one single surgeon.Methods:The retrospective and descriptive study was conducted. The clinico-pathological data of 240 patients who were performed RPD by one single surgeon at The First Affiliated Hospital of Sun Yat-sen University from July 2016 to October 2023 were collected. There were 130 males and 110 females, aged 59(19)years. All RPD were performed by the same surgeon. Observation indicators: (1) surgical situations; (2) postoperative pathological examination and outcome of patients. Measurement data with normal distribution were expressed as Mean± SD, and measurement data with skewed distribution were expressed as M(IQR). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations. Of 240 patients, 15 cases underwent combined vascular resection and reconstruction, and 13 patients were combined with other operations simultaneously. Of 240 patients, 4 cases converted to open surgery, with the conversion rate as 1.67%. The operation time of 240 patients was 458(152)minutes, volume of intraopera-tive blood loss was 50(50)mL, intraoperative erythrocyte transfusion was required in 17 patients. The R 0 resection rate was 99.17%(238/240), the number of lymph nodes harvested was 10(6) and duration of postoperative hospital stay was 17(12)days. (2) Postoperative pathological examination and outcome of patients. Of 240 patients, 51 cases were pancreatic ductal adenocarcinoma, 41 cases were ampullary carcinoma, 41 cases were neuroendocrine neoplasms, 35 cases were pancreatic cystic neoplasms, 28 cases were duodenal carcinoma and 44 cases were other pathologic types. Of 99 patients with major complications, there were 57 cases with clinically relevant postoperative pancreatic fistula, 44 cases with postoperative delayed gastric empty, 11 cases with postoperative biliary fistula, 8 cases with postoperative chyle fistula, 14 cases with incision infec-tion, and 24 cases with postoperative hemorrhage. Multiple complications might occur to the same patient. Reoperation was performed in 6 of the 240 patients. One patient died within 30 days after surgery. Twenty-four patients returned to hospital within 30 days after discharge. Conclusions:RPD performed by one single surgeon is safe and feasible, with favorable short-term outcomes, which can be performed in medical centers with experiences in robot-assisted pancreatic surgery.

Objective:To survey the quality of medical care and management for chronic obstructive pulmonary disease (COPD) in Shanghai community health service centers.Methods:A questionnaire survey on the institutional capacity for COPD care was conducted among 248 community health service centers in Shanghai from October to November 2023; the contents of self-designed questionnaire included the equipment, drugs, technical support, information exchange and management of COPD in the institutions. At the same time, a questionnaire survey on the knowledge and skill of COPD care was also conducted among half of all physicians selected by stratified sampling from half of the institutions selected by the random cluster sampling, including the knowledge about early screening, diagnosis, treatment and management of COPD, and related training needs .Results:(1)Survey results showed that the most common equipment for diagnosis and treatment of COPD available in community health centers was pulse oxygen saturation detector (97.6%, 242/248), X-ray radiography (96.8%, 240/248) and nebulizer (96.0%, 238/248), The availability of 6-min walking test system, non-invasive ventilator and rehabilitation training instrument in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of common COPD drugs in community health service centers were theophylline (91.5%, 227/248), oral glucocorticoid (85.9%, 213/248), intravenous glucocorticoid (81.0%, 201/248), the availability of oral and intravenous glucocorticoids in urban community health service centers was higher than that in rural ones ( P<0.05). The availability rates of COPD diagnosis and treatment techniques were 95.6% (213/248) for pulmonary function test, 93.5% (232/248) for pulse oxygen saturation test, and 53.2% (132/248) for non-invasive respiratory therapy. The availability rate of pulmonary function test, blood gas analysis, non-invasive ventilation and rehabilitation in urban centers was higher than that in rural centers ( P<0.05). Early screening of COPD was conducted in 85.1% (211/248) of community health service centers, the health record system and referral system were established in 66.5% (165/248) and 62.9% (156/248) of centers, respectively; and the establishment of outpatient and referral channels for respiratory diseases in urban areas was higher than that in rural areas ( P<0.05). (2)A total of 1 873 community doctors, aged(38.9±7.8)years and with (15.5±9.1)years of working experience, participated in the COPD knowledge and skill survey. The survey showed that 79.3% participants (1 485/1 873) knew the concept of COPD, 52.6% (986/1 873) mastered the diagnostic criteria, 41.6% (779/1 873) knew the risk factors and 15.5% (291/1 873) mastered the application of glucocorticoids. More than 79% of the community doctors showed the needs for training of knowledge, skills, rehabilitation of COPD and the performance of pulmonary function tests. Conclusion:Availability of COPD diagnosis and treatment equipment in community health center in Shanghai is different, and the availability of basic diagnosis and treatment equipment and drugs is better. The knowledge, skills and management of COPD need to be improved for community doctors, particularly in clinical application of pulmonary function test and active case finding.

Objective:To evaluate the safety and short-term efficacy of robotic-assisted resection for Bismuth-Corlette type Ⅲ and Ⅳ perihilar cholangiocarcinoma in Department of Pancreatobiliary Surgery,The First Affiliated Hospital,Sun Yat-sen University Methods:The clinical data of Bismuth-Corlette type Ⅲ and Ⅳ perihilar cholangiocarcinoma patients who have undergone robotic-assisted resection at The First Affiliated Hospital,Sun Yat-sen University between July 2017 and May 2023 were retrospectively studied.The clinicopathological features and perioperative outcomes of the patients were analyzed. Results:A total of 9 patients with Bismuth-Corlette type Ⅲ or Ⅳ perihilar cholangiocarcinoma,including 4 type Ⅲa patients,4 type Ⅲ b patients and 1 type Ⅳ patient,received robotic-assisted resection.1 patient converted to open surgery.The median operation time was 645 min[interquartile range(IQR):554-745 min],the median intraoperative blood loss was 300 mL(IQR:150-650 mL),and the median number of lymph node retrieval was 11(IQR:6-12).7 patients(77.8％)had R0 resection.5 patients(55.6％)had postoperative major complications(Clavein-Dindo classification was Ⅲ-Ⅴ),including intra-abdominal infection in 2 patients,liver function failure in 2 patients and upper gastrointestinal bleeding in 1 patient.1 patient underwent reoperation for the jejuno-jejunostomy bleeding 19 d after the initial operation and achieved good recovery.1 patient died within 30 d after initial operation due to liver function failure.The median length of postoperative hospital stay was 18 d(IQR:10-32 d). Conclusion:Robotic-assisted resection for Bismuth-Corlette type Ⅲ and Ⅳ perihilar cholangio-carcinoma is technically feasible and safe with good short-term efficacy,and can be performed in large-volume centers with ample experience in robotic-assisted hepatopancreatobiliary surgery.

Objective To evaluate the clinical efficacy and analyze the prognostic factors of radiotherapy after breast-conserving surgery for stage Ⅰ-Ⅱ breast cancer patients.Methods Clinical efficacy of adjuvant radiotherapy in 1 376 patients with stage Ⅰ and Ⅱ (T1-2 N0-1 M0/T3NoM0) breast cancer after undergoing unilateral breast-conserving surgery between 1999 and 2013 was retrospectively reviewed.Among them,930 patients (67.6％) received radiotherapy combined with chemotherapy including 517 receiving radiotherapy followed by chemotherapy and 413 receiving chemotherapy followed by radiotherapy.In total,1 055 patients (76.7％) were treated with endocrine therapy.Eighty-six patients (39.6％) positive for HER-2 received targeted therapy.The overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method.Univariate analysis was performed by Log-rank test and multivariate analysis was conducted by Cox regression method.Results The median follow-up time was 55 months.The quantity of patients receiving follow-up for ≥ 10 years was 90.The 5-and 10-year OS rates for all patients were 98.6％ and 91.5％,and 94.6％ and 82.8％ for 5-and 10-year DFS rates.Mutivariate analysis revealed that age (P=0.016),T staging (P =0.006),N staging (P =0.004),lymphovascular invasion (P =0.038) and time interval between radiotherapy and surgery (P=0.048) were independent prognostic factors for DFS rate.Multivariate analysis demonstrated that N staging (P=0.044) and ER (P=0.026) were independent prognostic factors for DFS in the radiotherapy alone group.Conclusions The radiotherapy-based comprehensive treatment yields favorable clinical outcomes for stage Ⅰ-Ⅱ breast cancer patients after undergoing breast conserving surgery.The prognostic factors for DFS include age,T staging,N staging,lymphovascular invasion and the time interval between radiotherapy and breast-conserving surgery.In the radiotherapy alone group,DFS rate is associated with N staging and ER level.

Objective:To investigate the impact of human umbilical cord-derived mesenchymal stem cells on the activation ,the survival of human peripheral blood mononuclear cell ( hPBMC) and the proportions of each human lymphoid subgroup .Methods:PB-MC were isolated from healthy donors by density gradient centrifugation , then cultured in MSC-CM as treatment group after being acti-vated by OKT3.Each lymphoid subgroup proportion was analyzed by flow cytometry to observe the difference between treatment and control group .The effect of MSC-CM on activated PBMC for the production of IFN-γand IL-10 were tested by ELISA .The level of ap-optosis was assessed by flow cytometry with Annexin-V/PI as fluorescent marker .Results:Compared with the control group , MSC-CM down-regulated the ratio of CD4 +T cell to CD8 +T cell, and increased the proportion of CD4 +CD25 +CD127low Treg cell, thus other subgroup had no significant difference .MSC-CM inhibited the production of IFN-γby PBMC, but promoted the secretion of IL-10, and protected PBMCs from apoptosis when activated with OKT 3.Conclusion:hUC-MSC may play a role of immunosuppression by promo-ting the proliferation and activation of Treg cell .This kind of inhibitory activity is neither relied direct or indirect contact with the lym -phocytes , nor influenced by inducing immune cells apoptosis .

BACKGROUND:Orthopedic osteotomy at the apex of kyphosis is best for treatment of ankylosing spondylitis from a biomechanical aspect, but there is a high risk for intraoperative spinal cord injury.
OBJECTIVE:To explore the clinical efficacy of vertebral plate osteotomy+vertebra osteotomy+long-segment pedicle screw fixation in the treatment of ankylosing spondylitis with kyphotic deformity.
METHODS:Thirty-six patients with ankylosing spondylitis were subjected to pedicle subtraction osteotomy and Smith-Peterson osteotomy, and then fol owed up for 3 months to 2 years.
RESULTS AND CONCLUSION:After implantation, sagittal imbalance did not occur in 36 patients, and the improvement rate of sagittal imbalance was 64%. The improvement rates of thoracolumbar kyphosis and chin-brow vertical angle were 60%and 98%, respectively. The pain relief rate was 64%, and the Oswestry Disability Index was 95%. There were no pul ed nails, broken nails and broken robs after implantation. These findings indicate that the combination of selective osteotomy technique and long-segment internal fixation can achieve stable fixation effects, prevent sagittal imbalance, and avoid the occurrence of pul ing nails, breaking nails and breaking robs caused by osteoporosis.

This study was aimed to build up a diagnosis and treatment procedure of traditional Chinese medicine (TCM) for HIV/AIDS headache. Domestic and foreign articles correlated to HIV/AIDS headache diagnosed and treat-ed by TCM were summarized. The specialist questionnaire of clinical diagnosis and treatment standard operating pro-cedures of TCM for HIV/AIDS headache was designed by focus group discussions. And the national specialist ques-tionnaire survey was carried out twice. The results showed that the standard operating procedure of TCM clinical di-agnosis, treatment, nursing and therapeutic efficacy assessment for HIV/AIDS headache was preliminarily established. It was concluded that this regulation identified concept, etiology and pathogenesis of HIV/AIDS, established TCM standard diagnosis and treatment service. It also demonstrated features of propaganda and education, follow-ups, con-secutive diagnosis and treatment inside or outside the hospital.

This study was aimed to establish traditional Chinese medicine (TCM) diagnosis and treatment procedure of varicella zoster virus (VZV) in AIDS, and to construct questionnaires for key points and revision of the procedure. The TCM draft of diagnosis and treatment procedure for VZV in AIDS was established through literature retrieval and peer review. Two rounds of surveys were carried out to investigate the confirmation and advice of in-group specialist to key points of TCM or integrative medicine draft including diagnosis, treatment and nursing. Then, diagnosis and treatment procedure were revised according to survey results. The results showed that the recovery of complete ques-tionnaires in the first-round survey was 96%. More confirmation of specialists were given to concept, clinical feature, cause, mechanism, case history and general examination, diagnostic criteria, syndrome differentiation and treatment of dampness-heat of liver channel syndrome, skin, dietary and psychological nursing, treatment course and therapeutic effect standard. The coefficient of variations (CVs) of experiential effective recipe, moxibustion and massage, auxiliary examination, syndrome differentiation and treatment of dampness stagnancy due to spleen deficiency syndrome and qi stagnation and blood stasis syndrome, and western medicine treatment were large. The weight coefficients of all items were within 0.043 6 and 0.046 2. The Cronbach Coefficient Alpha (CCA) was 0.996 and the split-half reliability R was 0.86. Recovery of complete questionnaires in the second-round survey was 100%. More confirmation of special-ists were given to outline, cause, mechanism, case history and general examination, diagnostic criteria, syndrome dif-ferentiation and treatment of three syndromes, experiential effective recipe, skin, dietary and psychological nursing. The CV was 0. The CV of auxiliary examination, moxibustion and massage was 0.063 8, which was less than those of first-round survey. The consistency of specialist was relatively increased. The weight coefficients of all items in the second-round survey were within 0.058 2 and 0.059 0. The CCA was -0.041 and the split-half reliability R was 0.79. A new revised procedure was preliminarily established according to results of two rounds of surveys. It was concluded that the activeness, concentration and coordination of specialists were good in two rounds of surveys. Con-sensus in key points of the procedure draft was reached including diagnosis, treatment and nursing.

BACKGROUND:Clinical treatment of hemivertebrae-induced congenital scoliosis is a complex medical problem. OBJECTIVE:To find the optimal treatment for hemivertebrae accompanied by congenital scoliosis.
METHODS:Total y 142 hemivertebrae patients who had received surgical treatment in the Department of Orthopedics, the 306 Hospital of Chinese PLA, China from 2010 to 2012 were enrol ed. The main surgical treatment was hemivertebrae resection and bone fusion with internal fixation, apical osteotomy for severe scoliosis and spinal shortening with internal fixation, one-stage posterior thoracolumbar osteotomy with internal fixation, spinal decompression with internal fixation.
RESULTS AND CONCLUSION:After treatment, the average correction rate was 70.9%for scoliosis and 71.7%for kyphosis. The fol ow-up period was 14-35 months, with an average of 23.4 months. By the end of the final fol ow-up, the loss rate for Cobb’s angle was 7.3%for scoliosis and 7.7%for kyphosis. Fol ow-up X-ray films showed bone fusion and internal fixation without loosening, fracture, and decompensation. Implementation of one-stage posterior thoracolumbar osteotomy with internal fixation can effectively correct hemivertebrae-induced kyphoscoliosis to obtain a satisfactory spinal sagittal and coronal balance.

ObjectiveTo evaluate the feasibility,safety and therapeutic efficiency of laparoscopic total mesorectal excision (TME) with anal sphincter preservation in the treatment of the middle-lower rectal cancer.MethodsFrom February 2008 to June 2010,37 patients with middle-lower rectal cancer received laparoscopic TME with anal sphincter preservation,while 45 patients underwent conventional open TME with anal sphincter preservation according to their wills.The operative procedures,postoperative recovery,postoperative complication and short-term outcome were collected and compared between the two groups.ResultsBlood loss was (60.6 ± 20.9) mL in laparoscope group which was significantly less than that in laparotomy group (P＜0.01),time for bowel movement retrieval and hospital stay were (3.3 ±0.6) and (9.2 ±2.8) days respectively,which were significantly shorter than those in laparotomy group (P ＜ 0.01 ).The incidence of postoperative complications was 8.1％ in laparoscope group,which was significantly lower than those in laparotomy group (P ＜ 0.05 ).The mean distance between resected margin and the tumor,the mean number of disected lymph nodes were not different between the two groups.The rate of sphincter preservation was 91.9％ in laparoscope group,which was higher than those in laparotomy group (73.3％) ( P ＜ 0.05 ).All patients were followed-up from 6 to 36 months,the recurrent rate and overall survival rate were 10.8％ and 94.6％ in laparoscope group,with no significant difference compared to those in laparotomy group (11.1％ and 91.1％,P ＞ 0.05).ConclusionsLaparoscopic TME with anal sphincter preservation which achieved the same effect of oncological clearance is a safe and feasible procedure for middle-lower rectal cancer,with less postoperative complications and better recovery after treatment,and enhances the rate of sphincter preservation,which is worthy of clinical application.