Surgical operation is the main treatment of oral and maxillofacial tumors.Dysphagia is a common postoperative complication.Swal-lowing disorder can not only lead to mis-aspiration,malnutrition,aspiration pneumonia and other serious consequences,but also may cause psychological problems and social communication barriers,affecting the quality of life of the patients.At present,there is no systematic evalua-tion and rehabilitation management plan for the problem of swallowing disorder after oral and maxillofacial tumor surgery in China.Combining the characteristics of postoperative swallowing disorder in patients with oral and maxillofacial tumors,summarizing the clinical experience of ex-perts in the field of tumor and rehabilitation,reviewing and summarizing relevant literature at home and abroad,and through joint discussion and modification,a group of national experts reached this consensus including the core contents of the screening of swallowing disorders,the phased assessment of prognosis and complications,and the implementation plan of comprehensive management such as nutrition management,respiratory management,swallowing function recovery,psychology and nursing during rehabilitation treatment,in order to improve the evalua-tion and rehabilitation of swallowing disorder after oral and maxillofacial tumor surgery in clinic.

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.

Objective　 : To obtain the peak skin dose (PSD) of patients with interventional cardiology procedures and toevaluate the risk of deterministic effects. Methods　 : Gafchromic XR RV3 films were used in a Level A tertiary hospital inBeijing to measure the PSD of patients who underwent interventional cardiology procedures. The measurement focused onfour common types of procedures, including coronary angiography, percutaneous transluminal coronary angioplasty,cathet-er radiofrequency ablation, and congenital heart disease. The films were scanned by EPSON EXPRESSION 10000XL andanalyzed by FILM QA ProTM 2014 software. Results　 : PSD was measured in 59 patients with interventional cardiologypro-cedures, including 23 with coronary angiography, 21 with percutaneous transluminal coronary angioplasty, 9 with catheterradiofrequency ablation, and 6 with congenital heart disease. The seven patients with PSD ≥ 2 Gy all underwentpercu-taneous transluminal coronary angioplasty, one with PSD > 3 Gy and six with PSD < 2 Gy. Conclusion　 The PSD of somepatients with interventional cardiology surgery exceeded the dose threshold of deterministic effects recommended by theICRP 118. There is a risk of deterministic effects in interventional cardiology surgery, especially in patients withpercu-taneous transluminal coronary angioplasty.

ObjectiveTo explore the potential mechanism of Qiling prescription in intervening in chronic atrophic gastritis with gastric intestinal metaplasia （GIM）. MethodThe 80 SPF-grade SD rats were randomly divided into the following eight groups （10 rats per group）： blank group， blank + Qiling prescription group， model group， high-dose Qiling prescription group， medium-dose Qiling prescription group， low-dose Qiling prescription group， folic acid group， and morodan group. Except for the blank and blank + Qiling prescription groups， the other groups underwent modeling by intragastric administration of 0.02 mol·L^-1 N-methyl-N′-nitro-N-nitrosoguanidine （MNNG） solution combined with irregular feeding. After successful modeling， the blank and model groups were given distilled water， the blank + Qiling prescription group， and high， medium， and low-dose Qiling prescription groups were given Qiling prescription water decoction at 7.60， 15.21， 7.60， 3.80 g·kg^-1， respectively， the folic acid group was given folic acid suspension at 0.002 g·kg^-1， the morodan group was given morodan suspension at 1.40 g·kg^-1 by gavage once a day for 8 weeks. The general condition and body weight of the rats were observed during the experiment. Hematoxylin-eosin （HE） staining was performed on gastric tissues. Immunohistochemistry （IHC） was used to detect the levels of mucin 2 （MUC2） and caudal-type homeobox transcription factor 2 （CDX2） in gastric tissues. Enzyme-linked immunosorbent assay （ELISA） was used to measure the serum levels of interleukin-6 （IL-6）， interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， cysteine-aspartic protease-3 （Caspase-3）， phosphatidylinositol 3-kinase （PI3K）， and protein kinase B （Akt）. Western blot analysis was performed to detect the expression and phosphorylation levels of PI3K and Akt in gastric tissues. ResultAnimal experiments showed that compared to the blank group， the rats in the model group had a trend of weight loss starting from week 16. Compared to the model group， high and medium doses of Qiling prescription improved the mental state and body weight of the rats. Pathological results at week 24 showed successful modeling with reduced gastric mucosal glandular cells and disordered arrangement in the model group compared to the blank group. The high and medium-dose Qiling prescription groups showed significantly fewer or absent goblet cells， indicating improved gastric mucosal pathology as compared to model group. Compared to blank group， the model group showed increased levels of MUC2 and CDX2 in gastric tissues （P<0.01）. High and medium doses of Qiling prescription significantly reduced the levels of MUC2 and CDX2 in gastric tissues compared to the model group （P<0.05，P<0.01）. Compared to the blank group， the model group had increased serum levels of IL-6， IL-1β， TNF-α， Caspase-3， PI3K， and Akt （P<0.05）. Compared with the model group， high-dose Qiling prescription significantly reduced the serum levels of IL-1β， Caspase-3， PI3K， and Akt （P<0.01）， medium-dose significantly reduced the levels of IL-6， IL-1β， TNF-α， Caspase-3， PI3K， and Akt （P<0.05，P<0.01）. Compared to the blank group， the model group showed significantly increased expression of PI3K and Akt in gastric tissues. High-dose Qiling prescription significantly inhibited Akt protein expression compared to the model group （P<0.01）. ConclusionQiling prescription may alleviate GIM and delay inflammation-cancer transformation through multi-component， multi-target， and multi-pathway mechanisms by inhibiting the PI3K/Akt pathway， reducing the release of pro-inflammatory factors， and inhibiting gastric mucosal epithelial cell apoptosis.

Currently, congenital heart disease is still the main cause of infant death, and surgery is the main treatment to correct congenital cardiac structural malformations. In the treatment of some complex congenital heart diseases, valved conduits are used to reconstruct the right ventricular to pulmonary artery connection and reconstruct the anatomy and hemodynamics of the normal right ventricular outflow tract. This article reviews the current usage, advantages, and disadvantages of the most commonly used right ventricular to pulmonary artery valved conduits in clinical practice: homogeneous valved conduits, heterogeneous valved conduits, and polytetrafluoroethylene valved conduits, and the right ventricular to pulmonary artery valved conduits which are emerging with the advancement of materials science and have clinical application prospects are also discussed.

Objective:To investigate the clinical experience of different types of femoral perforator flaps in the reconstruction of oral and maxillofacial head and neck defects.Methods:From January 2018 to January 2021, 573 patients with oral and maxillofacial head and neck defects reconstructed by femoral perforator flap were collected in the Department of Maxillofacial Oncology, the Third Affiliated Hospital of Air Force Military Medical University (age range of 21-76 years, with a male to female ratio of 1.23∶1). According to the type of perforator flap, the patients were divided into ALT group, AMT group, TFL flap group and free muscle flap group. The incidence of postoperative complications, wound healing time and drainage volume in femoral area were compared among the 4 groups.Results:The ALT flap was used in 527 cases: 22 flaps had vascular crisis, 14 flaps had infection, 8 flaps had necrosis, 519 flaps survived; the mean healing time of the wound was (14.50±3.19) days, and the mean drainage volume was (49.9±21.3) ml. 28 cases were repaired with AMT flap: 2 flaps had vascular crisis and 1 had infection. All the flaps survived; the mean healing time of the wound was (14.18±2.75) days, and the mean drainage volume was (50.3±23.0) ml. 11 cases were repaired by TFL flap: 1 flap had vascular crisis and 1 had infection. All the flaps survived. The mean healing time of the wound was (14.09±2.66) days, and the mean drainage volume was (54.1±25.0) ml. 7 cases were repaired by free muscle flap survived without vascular crisis, infection and other postoperative complications; the mean healing time of the wound was 14.14±1.86, and the mean postoperative drainage volume was (49.9±21.1) ml. There was no significant difference in complication rate (flap necrosis, vascular crisis, infection, etc.) and repair effect among 573 patients with different flap types. The postoperative follow-up was conducted for 6-24 months, and the donor area was smooth and good in appearance, without obvious scar or functional influence. The repair effect of the affected area was satisfactory.Conclusions:Although there is a certain proportion of perforator vessel variation in the femoral perforator flap, the flap can be designed freely according to different types of variation. The thigh perforator flap has an essential application value in the repair of oral and maxillofacial head and neck defects.

【Objective】 To investigate the predictive value of visceral fat area （VFA） in patients with gastric cancer after radical gastrectomy. 【Methods】 A retrospective analysis was performed on 195 patients who underwent radical gastrectomy in the Department of General Surgery， The First Affiliated Hospital of Xi’an Jiaotong University from January 2014 to December 2017. CT image data and clinicopathological data within 1 week before surgery were collected. VFA was calculated by software， and the patients were divided into VFA-H group （n=96） and VFA-L group （n=99）. The relationship between VFA in different groups and long-term prognosis was compared. 【Results】 CT examination results showed that VFA value was （111±62） cm²， and BMI was positively correlated with VFA value （r=0.640， P<0.001）. ROC curve showed that VFA was more valuable in predicting the prognosis of gastric cancer （AUC=0.703， P<0.001） and better than BMI. Cox regression analysis of prognostic factors in gastric cancer patients： Univariate analysis showed that age， tumor length， TNM stage and VFA were the influencing factors for prognosis， while multivariate analysis showed that TNM stage III and VFA-L were independent risk factors for prognosis of gastric cancer patients. 【Conclusion】 VFA has a good predictive ability and can be used to evaluate the prognosis of gastric cancer patients after operation.

Objective:To analyze the characteristics and surgical outcomes of Shone′s syndrome in children, and to explore the surgical treatment strategy and technical key.Methods:Retrospective study.Children with Shone′s syndrome treated in the Pediatric Heart Center, Beijing Anzhen Hospital, Capital Medical University from May 2013 to June 2019 were retrospectively analyzed for their baseline characteristics and surgical data.The data were compared by Student t-test. Results:A total of 22 children with Shone′s syndrome were recruited, involving 15 males (68.2%) and 7 females (31.8%). There were 6 cases (27.3%) of complete form of Shone′s syndrome and 16 cases (72.7%) of incomplete form.No deaths were reported.The postoperative mitral valve velocity [(149.7±38.2) cm/s vs.(234.9±34.0) cm/s, t=7.341, P<0.05], left ventricular outflow tract velocity [(202.0±105.0) cm/s vs.(328.6±120.3) cm/s, t=6.575, P<0.05] and aortic arch coarctation velocity [(186.1±60.9) cm/s vs.(347.9±100.8) cm/s, t=7.630, P<0.05]were significantly lower than those of preoperative levels.There were no complications occurred at 1-year follow-up, and 91.7% of the patients were followed up for 3 years, and 80.2% were followed up for 5 years without complications, 2 cases needed reoperation. Conclusions:Surgical treatment of Shone′s syndrome achieved satisfactory outcomes.Early diagnosis and early intervention are beneficial to children with Shone′s syndrome, although they need to be followed up and have the risk of reoperation in the long term.

Laparoscopic proximal gastrectomy (LPG) can be selected for the treatment of early upper gastric carcinoma, but gastroesophageal reflux after operation would seriously affect the quality of life of patients. Esophagogastric anastomosis with double flap technique is a digestive tract reconstruction method using the anastomosis between the esophagus and the anterior wall of the stomach. Compared with other digestive tract reconstruction methods, esophagogastric anastomosis with double flap technique can maintain the postoperative body mass of patients in good condition, improve the nutritional status and the long-term quality of life of patients. Esophagogastric anasto-mosis with double flap technique has good anti reflux effects and retain the possibility of endoscopic examination and treatment. By reviewing literatures at home and abroad, and combined with clinical experiences, the authors discuss current status and digestive tract reconstruction methods of LPG, and deeply investigate the application prospect of esophagogastric anastomosis with double flap technique.

ObjectiveT o explore the influence of patch shape for intraventricular tunnel (IVT) construction on biomechanical performance of the double outlet right ventricle after correction. Methods Based on the idealized IVT model, a two-dimensional IVT patch was designed. Six groups of patch models with the rhombic long-to-short axis ratio of 1∶0.625, 1∶0.3, 1∶0.2, 1∶0.15, 1∶0.125, 1∶0.1 were established according to the difference between the long and short axis of the rhombus patch in the turning part, and finite element analysis method was used to numerically simulate the process of stitching, holding and propping up the patch into a three-dimensional (3D) IVT model. Results The maximum stresses on suture line of 6 patch models were mainly concentrated at acute-angle corners of the rhombus. As rhombic long-to-short axis ratio of the patch increased, the maximum stress of the IVT suture line first decreased and then increased, and the volume showed an increasing trend. The pressure difference between two ends of the tunnel first decreased and then increased. The patch with the long-to-short axis ratio of 1∶0.15 had a uniform surface stress distribution, and the maximum stress on the suture line was the smallest. Meanwhile the right ventricular volume was less encroached on, and the pressure difference at both ends of the tunnel was small. Conclusions The IVT shape can influence stresses of suture line, the right ventricle volume and the pressure difference of IVT with non-monotonic variations. The suture effect of the patch with the long-to-short axis ratio of 1∶0.15 is relatively better among the constructed models.