Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

Objective:To explore the efficiency of a modified caries risk assessment tool(MCAT)on caries-risk prediction of children in Nanning.Methods:MCAT was designed based on caries-risk assessment tool(CAT)of American Academy of Pediatric Dentistry(AAPD)and the caries related factors of the primary school children in Guangxi,China.A cohort study was conducted in 332 children aged 3-year-old in kindergarten of Jiangnan District,Nanning,Guangxi.The data were integrated through questionnaires and oral exam-ination.The MCAT data were respectively scored by CAT and Cariogram and the caries-risk of the children was evaluated.The develop-ment of increased average caires incidece over a period of 1.5 years was compared,the predictive capacity of the methods was com-pared.Results:The ranks of caires risk assessed by CAT and Cariogram were significant different(Z=-10.34,P＜0.001),and the consistency of the 2 methods was poor(Kappa=0.234,P＜0.001).After 1.5 years,there was significant statistical difference of the caries prevalence rate between the low-high and moderate-high risk groups,and dmft increments between the moderate-high risk groups e-valuated by CAT(P＜0.05).There was significant difference of the caries prevalence rate between each risk groups and dmft increments between the low-high and moderate-high risk groups evaluated by Cariogram(P＜0.05).The AUC of CAT and Cariogram was 0.571 and 0.722 respectively(P＜0.001).In the prediction models of caries risk,the fitting of CAT was poor(P＜0.001),while that of Cariogram was better(P=1.00).Cariogram analysis showed that the chance of developing new caries lesions of the subjects with moderate and high caries risk was 2.86 and 11.65 times more than those with low caries risk.Conclusion:MCAT com-bined with Cariogram can more efficiently predict new caries de-velopment in 3-year-old children.

Objective:To analyze clinical characteristics and genetic characteristics of children with ATP sensitive potassium passage (K ATP-HI). Methods:Forty-five children with genetically confirmed K ATP-HI and their families admitted to Beijing Children′s Hospital of Capital Medical University between February 2002 and December 2018 were selected as the study subjects. A detailed retrospective analysis of the patient's clinical characteristics, diagnosis and treatment process, disease-causing gene carrying status and later follow-up data was performed. ABCC8/KCNJ11 gene was sequenced by second-generation sequencing technology. Results:Among 45 children with K ATP-HI, 34 cases (75.6%) were neonatal onset, the first symptoms of 21 cases (46.7%) were convulsions. 39 cases had been treated with diazoxide, including 12 cases (30.8%) with good efficacy, 16 cases (41%) with poor efficacy and 11 cases with uncertain efficacy. Octreotide was further applied in 18 patients with uncertain or ineffective efficacy after diazoxide treatment, and 13 cases (72.2%) were effective, 3 cases were ineffective, and 2 cases were uncertain. 10 CHI patients who were ineffective to drug treatment or had clearly focal lesions confirmed by 18F-dopa positron emission by computed tomography ( 18F-DOPA PET) scans had undergone surgical treatment, 8 of which underwent partial pancreatectomy and blood glucose returned to normal after the operation; the other 2 cases underwent subtotal pancreatectomy and both had secondary diabetes after operation. Among 45 children with K ATP-HI, 1 case carried both ABCC8 and KCNJ11 mutations, 10 cases carried ABCC8 compound heterozygous mutations, and the remaining 34 cases carried ABCC8/KCNJ11 single genetic mutation. Among them, 21 cases had paternal inheritance, and 3 cases had maternal inheritance, 6 cases were identified with de novo mutations. Conclusions:Diazoxide treatment was ineffective for most K ATP-HI children, but octreotide had a higher effective rate. Partial pancreatectomy for focal type patients had a higher cure rate, and there was a risk of secondary diabetes after subproximal pancreatectomy, so it was very important to clarify the histological type of children before surgery. ABCC8 gene mutations and KCNJ11 gene mutations were the main pathogenic genes of K ATP-HI. Among patients carrying mutations in single ABCC8 or KCNJ11 gene mutation, K ATP-HI inherited by paternity were the majority. Some K ATP-HI children can relieve the hypoglycemia symptoms by themselves.

Objective To investigate the clinical significance of Wiguide needle guidance ultrasound technology in radial artery puncture . Methods One hundred and thirty‐five patients who would receive elective surgery requiring radial artery puncture and catheterization to monitor invasive blood pressure were randomly divided into 3 groups( n ＝45) :blind puncture group( group A ) ,ultrasound puncture group( group B) and Wiguide needle guidance ultrasound puncture group ( group C ) . T he diameter and depth of radial artery ,blood return time ,puncture time for the process and the puncture success rate were recorded and compared . Results T here was significant diffeence in the blood return time among three groups ( P ＝0 .039) ,the blood return time in group B was higher than in group A and C ( P ＝ 0 .029 ,0 .027 ) . T he difference was statistically significant in the puncture time among three groups ( P ＝0 .002) ,the puncture time in group B was higher than in group A and C ( P ＝0 .009 ,0 .001) . T he puncture success rate in group A was 71 .11% ,the puncture success rate were 100% in both group B and C . Conclusions Wiguide needle guidance ultrasound technology could effectively improve the skill of vascular puncture ,which shortens the puncture time and improves the success rate of puncture . Wiguide needle guidance ultrasound technology provides benefits to master the ultrasound‐guided vascular puncture for clinical work .

Objective: To investigate the clinical significance of Wiguide needle guidance ultrasound technology in radial artery puncture. Methods: One hundred and thirty-five patients who would receive elective surgery requiring radial artery puncture and catheterization to monitor invasive blood pressure were randomly divided into 3 groups(n=45): blind puncture group(group A), ultrasound puncture group(group B) and Wiguide needle guidance ultrasound puncture group(group C). The diameter and depth of radial artery, blood return time, puncture time for the process and the puncture success rate were recorded and compared. Results: There was significant diffeence in the blood return time among three groups (P=0.039), the blood return time in group B was higher than in group A and C (P=0.029, 0.027). The difference was statistically significant in the puncture time among three groups (P=0.002), the puncture time in group B was higher than in group A and C (P=0.009, 0.001). The puncture success rate in group A was 71.11%, the puncture success rate were 100% in both group B and C. Conclusions Wiguide needle guidance ultrasound technology could effectively improve the skill of vascular puncture, which shortens the puncture time and improves the success rate of puncture. Wiguide needle guidance ultrasound technology provides benefits to master the ultrasound-guided vascular puncture for clinical work.

Four new limonoid-type nortriterpenoids, 1-detigloyl-1--methacryloylsalannin (), 28-deoxo-2,3-dihydronimbolide (), 12-acetoxy-3--acetyl-7--tigloylvilasinin () and 12-acetoxy-3--acetyl-7--methacryloylvilasinin (), along with five known ones, were isolated from seeds of A. Juss. Their structures were elucidated by various spectroscopic methods, including UV, IR, MS, NMR, X-ray crystallography, quantum chemical calculation, as well as by comparison of their spectroscopic data with those reported. In the cytotoxic assay, showed inhibitory activity against human breast cancer MDA-MB-231 cell line with IC value of 7.68±1.74 μmol/L, and inhibited growth of human cervical cancer Hela cell line, melanoma A375 cell line and promyelocytic leukemia HL-60 cell line, with IC 12.00±2.08, 17.44±2.11, and 13.95±5.74 μmol/L, respectively.

Objective To investigate the effects of structured triglyceride and long chain triglyceride/medium chain triglyceride (LCT/MCT) on postoperative efficacies of elderly patients (≥70 years old) after total gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinical data of 42 elderly patients who underwent total gastrectomy for gastric cancer in the Jiangsu Cancer Hospital between Sepember 2014 and September 2015 were collected.Twenty-two patients using structured triglyceride in postoperative parenteral nutrition and 20 using LCT/MCT in postoperative parenteral nutrition were allocated into the case and control groups,respectively.All the patients underwent total gastrectomy + Roux-en-Y esophagojejunostomy.Patients in the case and control groups received respectively 20％ structured triglyceride and 20％ LCT/MCT.Observation indicators:(1) postoperative recovery situation:time of gut exsufflation,changes of body mass at postoperative 5 days,postoperative anastomotic leakage and abdominal infection;(2) test of liver function indexes:aspartate transaminase (AST),alanine transaminase (ALT),total bilirubin (TBil),direct bilirubin (DBil) of liver function in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5;(3) test of nutritional indexes:serum total protein (TP),albumin (Alb) and prealbumin in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5;(4) test of immunological indexes:levels of IgG and IgA,CD3,CD4 and ratios of CD3/CD8 in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5.Measurement data with normal distribution were represented as x ±s.Repeated measures data were evaluated with the repeated measures ANOVA.Count data were analyzed using the chi-square test and Fisher exact probability.Results (1) Postoperative recovery situation:there was no special adverse reaction during support treatment of parenteral nutrition.Time of gut exsufflation,changes of body mass at postoperative 5 days,incidences of postoperative anastomotic leakage and abdominal infection were (46 ± 12)hours,(60±8) kg,0,0 in the case group and (50 ±14) hours,(58±9)kg,0,1 in the control group,respectively,with no statistically significant difference between the 2 groups (t =0.86,0.65,P＞0.05).(2) Test of liver function indexes:levels of AST and ALT from preoperation to postoperative day 5 were respectively from (24±9) U/L to (22±6)U/L,from (31±12)U/L to (20±8)U/L in the case group and from (23±8) U/L to (30± 10) U/L,from (30 ± 9) U/L to (32 ± 7) U/L in the control group,respectively,with statistically significant differences between the 2 groups (F =92.87,87.92,P＜0.05).Levels of TBil and DBil from postoperative day 1 to postoperative day 5 were respectively from (21±4) μmol/L to (19±4) μmol/L,from (7.0±2.0) μmol/L to (6.0±2.0)μmol/L in the case group and from (19±3) μmol/L to (20±4)μmol/L,from (7.0±2.0)μmol/L to (8.0±3.0)μmol/L in the control group,respectively,with no statistically significant difference between the 2 groups (F =1.48,0.81,P ＞ 0.05).(3) Test of nutritional indexes:levels of serum TP and Alb from postoperative day 1 to postoperative day 5 were respectively from (52±6)g/L to (56±5)g/L,from (34±3)g/L to (37±4) g/L in the case group and from (53±7)g/L to (52±4)g/L,from (33±3) g/L to (31± 3)g/L in the control group,respectively,with no statistically significant difference in changing trends between the 2 groups (F=0.47,0.54,P ＞ 0.05).Levels of prealbumin from postoperative day 1 to postoperative day 5 were respectively from (230±32)mg/L to (245±30)mg/L in the case group and from (228±28)mg/L to (222±26) mg/L in the control group,respectively,with a statistically significant difference in changing trend between the 2 groups (F=16.81,P＜0.05).(4) Test of immunological indexes:levels of IgG and IgA,CD3,CD4 and ratios of CD4/CD8 from postoperative day 1 to postoperative day 5 were respectively from (12±4) g/L,(2.20±0.20)g/L,52％±4％,30％±4％,1.30±0.20 to (18±5)g/L,(2.80±0.30)g/L,59％±4％,33％±4％,1.50±0.20 in the case group and from (12±3)g/L,(2.10±0.10)g/L,52％±4％,27％±4％,1.30±0.10 to (13±4)g/L,(2.30±0.20) g/L,51％±4％,26％ ±4％,1.20±0.20 in the control group,respectively,with statistically significant differences in changing trends between the 2 groups (F=25.07,29.42,33.53,22.19,33.47,P＜0.05).Conclusions The short-term usage of structured triglyceride or LCT/MCT in early period after operation can effectively improve postoperative recovery of elderly patients with gastric cancer,with a small impact on liver function.Structured triglyceride can improve immunologic function and nutrition status more effectively.

Objective To determine whether store-operated Ca2+ entry (SOCE) is involved in chronic hypoxia-induced alteration of intracellular Ca2 + concentration ([Ca2+] i) and proliferation in pulmonary arterial smooth muscle cells (PASMC).Methods Rat PASMCs were cultured and treated in normoxia (21％O2) or hypoxia (4％ O2) condition.The proliferation of PASMC was detected by cell counting kit-8 (CCK-8) assay.[Ca2 +] i,SOCE and the effects of store-operated Ca2 + channel (SOCC) inhibitors,SKF96365 and NiCl2,on SOCE in hypoxic PASMCs were tested by InCyte [Ca2 +] i measurement system.Results Hypoxia for 24-60 h augmented PASMC proliferation (1.12 ± 0.09 vs 0.71 ± 0.05,P ＜ 0.05) and [Ca2 +] i [(214.8 ± 20.4) nmol/L vs (115.2 ± 13.2) nmol/L,P ＜ 0.05] in a time-dependent manner with the maximum effect at 60 h.Perfusion of Ca2+-free Krebs solution containing nifedipine (5 μ mol/L),cyclopiazonic acid (CPA,10 μmol/L) in PASMCs caused a small transient increase of [Ca2+]i with peak [Ca2+]i (113.3 ± 49.3) nmol/L.Chronic hypoxia (4％ O2,60 h) enhanced [Ca2+]i level with peak value of (193.2 ± 22.7) nmol/L (P ＜ 0.05) in PASMC.After restoration of extracellular Ca2+,CPA caused marked increase of [Ca2+]i with peak value of (328.0 ± 56.7) nmol/L.Chronic hypoxia strengthened CPA-induced increase of [Ca2 +] i with peak value of (526.0 ± 33.7) nmol/L (P ＜ 0.05) in PASMCs.Either SKF96365 50 μmol/L or NiCl2 500 μmol/L distinctly attenuated CPA-induced enhancement of [Ca2 +] i,the peak value of which dropped from (526.0 ± 33.7) nmol/L to (170.4 ± 26.4) nmol/L (P＜0.05) or (177.4±45.9) nmol/L (P＜0.05) respectively.Conclusion Chronic hypoxia boosts the release of Ca2+ from sarcoplasmic reticulum and promotes the activity of SOCC and SOCE,leading to [Ca2 +] i elevation and proliferation of rat PASMCs.

Connexin (Cx) is the main component of gap junction channels, which is essential for intercellular communication between adjacent cells.Cx plays an important role in regulation of the growth, differentiation and apoptosis of cells and is closely related to tumor formation and development.The expression of Cx appears to be different in different stages of tumor development, and the regulatory mechanism of Cx is also involved in many aspects.In this paper, recent advances in the studies on Cx are reviewed, including the relationship between Cx and development of tumor, the basic mechanism of Cx, as well as its applications in antitumor-drug screening and tumor therapy.