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 explore the effectiveness of high-definition diffusion weighted imaging(DWI)sequence combined with T1 WI-fat suppression(FS)dynamic contrast enhancement(DCE)sequence for preoperative T-stage of rectal cancer by using 3.0T MRI standardized scanning.Methods A retrospective analysis was conducted on MRI images of 57 patients with rectal cancer confirmed by pathology.Before surgery,the patients underwent 3.0T MRI standardized rectal cancer scan methods,including routine sequence,high-definition DWI sequence,and T1 WI-FS DCE sequence,etc.Then two experienced physicians evaluated the T-stage of preoperative rectal cancer through high-definition DWI(transverse and sagittal sections)and T1 WI-FS DCE sequences in the double-blind method.Using the postoperative pathological results of rectal cancer as the"gold standard",two sequences were combined to evaluate the accuracy,sensitivity,and specificity of rectal cancer T-stage.Results Among the 57 cases,there were 9 cases of upper rectal cancer,39 cases of middle rectal cancer,and 9 cases of lower rectal cancer.The accuracy rates of preoperative T-stage diagnosis for rectal cancer by two evaluator were both 85.7％(6/7)in T1 stage,88.2％(15/17)and 94.1％(16/17)in T2 stage,96.9％(31/32)and 93.8％(30/32)in T3 stage,and both 100.0％(1/1)in T4 stage.For evaluator 1,the sensitivity and specificity of the rectal cancer T-stage diagnosis were 96.1％and 83.3％,and for evaluator 2 were 94.1％and 83.3％,respectively.For rectal cancer MRI diagnosis,the accuracy rates and sensitivity were higher when combining the high-definition DWI sequence and T1 WI-FS DCE sequence,compared with a single high-definition DWI sequence or T1 WI-FS DCE sequence,and the difference was statistically significant.The average preoperative apparent diffusion coefficient(ADC)value of rectal cancer was compared between the corresponding postoperative pathological T1 to T4 stage groups,and the difference was statistically significant.Conclusion The combination of high-definition DWI sequence and T1 WI-FS DCE sequence improves the accuracy of rectal cancer T-stage,providing assistance for personalized clinical treatment.

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.

【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 confirm whether the preoperative fibrinogen to pre-albumin ratio (FPR) is a prognostic factor for patients with gastric adenocarcinoma and to analyze the relationship between FPR and clinicopathological characteristics of gastric adenocarcinoma patients. 【Methods】 We retrospectively reviewed the clinical data of 404 patients with gastric cancer who received radical gastrectomy in the Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, from January 2012 to December 2016. We analyzed the preoperative FPR’s effects on the prognosis of patients with gastric cancer and the relationship between FPR and the clinicopathological variables. 【Results】 The optimal cut-off point of FPR obtained by ROC curve analysis was 15.0, and gastric cancer patients were divided into low FPR group (<15.0) and high FPR group (≥15.0). The univariate Cox regression analysis showed that age, preoperative anemia, tumor size, histological grade, TNM stage, and preoperative FPR were risk factors for the prognosis of gastric cancer (P<0.05). The multivariate Cox regression analysis showed that TNM stage and preoperative FPR were independent prognostic factors for gastric cancer (P<0.05). The subgroup analysis results indicated that the prognosis of patients in the low FPR group was better than that in the high FPR group of patients with stage Ⅰ-Ⅱ and stage Ⅲ gastric cancer (P<0.05). Further analysis showed that compared with those in the high FPR group, patients in the low FPR group had an older age, a larger proportion of males, a lower rate of anemia before surgery, smaller tumor diameter, and earlier TNM staging (P<0.05). 【Conclusion】 The preoperative FPR is an independent prognostic factor for gastric cancer. This study provides a clinical basis for its application in predicting the long-term prognosis of patients with gastric cancer.

Objective: To understand secular trend of sedentary behaviors of school-aged children and adolescents in leisure time in China, and to provide theoretical basis for health behavior intervention. Methods: Data from China Health and Nutrition Survey (CHNS) during 2006 to 2015 were used to analyze leisure sedentary behaviors of children and adolescents aged 6-17 years. Means and medians were used for basic description and trend analysis, and nonparametric test was used for statistical comparison. Results: The total time of sedentary behavior during leisure time among children and adolescents aged 6-17 years showed a significant increasing trend, in which computer time contributed the most, especially among 6-11-year-old group with a five-fold increase. The time spent watching TV and doing homework slightly decreased. There was no sex difference in the total sedentary time during leisure time(Z=1.74，1.54，0.08，1.50，P>0.05), but there was sex difference in time spent in computer and homework(Z=2.00，2.01，2.84，2.92，P>0.05). Total sedentary time, as well as sedentary time spent in watching TV, computer, and homework differed by age and areas(Z=52.49-75.21，54.21-136.31，24.58-44.55; 6.25-8.61，6.42-13.34，3.89-6.42，P<0.01). Conclusion Over the last decade, sedentary behavior increased during leisure time among Chinese children and adolescents, and the usage pattern has also changed substantially. Results suggest that relevant departments should adopt more strategies to reduce sedentary behaviors and strengthen physical activities.

Objective: To build an automatic bone age assessment system based on China 05 Bone Age Standard and the latest deep learning technology, and preliminary clinical verification was carried out. Methods: The left-hand radiographs of 5 000 children with suspected metabolic disorders were acquired from Wuxi Children′s Hospital. Among these cases, 2 351 patients were randomly chosen as training set, and 101 patients were randomly used as validation set. Four professional pediatric radiologists annotated the development stage according to the China 05 RUS-CHN standard with double-blind method. The mean value of the bone age assessed by experts was the reference standard which was used to train and validate the deep learning mothods based artificial intelligence (AI) model. Accuracy, mean absolute error (MAE), root mean squared error (RMSE) and time efficiency of bone age assessment were compared by using Chi-square test and t test and F test between resident doctors and AI model in the validation set. Results: The MAE and RMSE was (0.37±0.35) years and 0.50 years between AI model and reference standard, respeactively. When the error range was within ±1.0, ±0.7 and ±0.5 years, the accuracy of model on the validation set was 94.1% (95/101), 89.1% (90/101), 74.3% (75/101) respectively. The accuracy between two resident doctors and AI prediction wasn′t statistical significant (P>0.05). Conclusion The AI model of bone age assessment based on deep learning is feasible and has the characteristics of high accuracy and efficiency.

Objective To elucidate the mechanism underlying eletroacupuncture's (EA's) amply-documented analgesic effect.To observe its effect on the pain threshold and on the expression of P2X4 receptor and microglia activation in the spinal cords of rats with neuropathic pain.To demonstrate whether or not interfering with A1 receptors and P2X4 receptors at the same time could enhance the analgesic effect.Methods A total of 40 SpragueDawley rats weighing 150 to 180 g were randomly divided into a sham group,a CCI group,an EA group,a 2-chloroN(6)-cyclopentyladenosine (CCPA) group and a CCPA+EA group,each of 8.Chronic constriction injury (CCI)was induced successfully in the rats of all groups except the sham group.Five days later,EA and 20 μL injections of 0.1 mm/L CCPA were applied to the rat analogues of the Zusanli (ST36) and Yanglingquan (GB34) acupoints once a day for 15 days for the rats in the appropriate groups.The mechanical withdrawal threshold (MWT) and the thermal withdrawal latency (TWL) were measured before the CCI operation and 20 days afterward.L4-L6 spinal cord tissue was then resected and the fluorescence intensity of P2X4 and OX42 receptors was detected using double label immunohistochemical staining.The correlation between the mean fluorescence intensity and the pain threshold gap was analyzed.Results The average MWT and TWL of the CCI group were significantly lower than in the other four groups.The expression of P2X4 receptor and OX42 in the spinal cord increased significantly in the CCI group compared to the other four groups.There was significant correlation between the mean fluorescence intensity of P2X4 and OX42 receptors and the gap in pain threshold,with correlation coefficients of 0.907 and 0.717 respectively.Conclusion P2X4 receptor and microglia activation might be involved in the development of neuropathic pain.CCPA and EA can inhibit the activation of microglia and reduce the activity of P2X4 receptors.The interaction between A1 receptors and P2X4 receptors can strengthen the analgesic effect of EA.

Objective To evaluate the effect of sevoflurane preconditioning on autophagy in the operated lung tissues of the patients undergoing one-lung ventilation.Methods Forty patients of both sexes,with American Society of Anesthesiologists physical status Ⅰ-Ⅲ,aged 30-80 yr,weighing 45-84 kg,scheduled for elective radical operation for lung cancer performed via video-assisted thoracoscope under general anesthesia,were divided into control group (C group) and sevoflurane preconditioning group (SP group),with 20 patients in each group.In SP group,sevoflurane was inhaled for 30 min with the final concentration of 2.0％,followed by washout.The normal lung tissues (the distance from the edge of the lump＞2 cm) around the lump were obtained for detection of the expression of microtubule-associated protein 1 light chain 3 Ⅱ by Western blot.Results Compared with C group,the expression of microtubule-associated protein 1 light chain 3 Ⅱ in lung tissues was significantly up-regulated in SP group (P＜0.05).Conclusion Sevoflurane preconditioning can enhance autophagy in the operated lung tissues of the patients undergoing one-lung ventilation,which may be related to the lung protective effect.

Objective To evaluate the value of the 7-joint ultrasound score (US7) in treatment of rheumatoid arthritis (RA) with Chinese and western medicine.Methods A total of 160 RA patients were divided into 2 groups based on different methods of treatment,including Yi Shen Qing Luo (YSQL) group and western medicine group.The patients were examined by grey scale ultrasound (GSUS) and power Doppler ultrasound (PDUS) with US7 at baseline and after 3 and 6 months later.There were 7 related joints and 5 single factors for scoring in US7 system.The joints included the wrist joints,the second/third metacarpophalangeal joints (MCP Ⅱ/Ⅲ),the second/third proximal interphalangeal joints (PIP Ⅱ / Ⅲ) and the second/fifth metatarsophalangeal joints (MTP Ⅱ/Ⅴ).And the factors included synovitis of GSUS,synovitis of PDUS,myotenositis/tenosynovitis of GSUS,myotenositis/tenosynovitis of PDUS and bone erosion (ES).Meanwhile,the laboratory index included C-reactive protein (C-RP) and erythrocyte sedimentation rate (ESR) were examined.And the clinical indexes as disease activity score in 28 joints (DAS28) were evaluated.Results The statistical differences of synovitis of GSUS,synovitis of PDUS,myotenositis/tenosynovitis of GSUS and myotenositis/tenosynovitis of PDUS scores in US7 system were found in both 2 groups at baseline,3 months and 6 months after treatment (all P＜0.01).There was no statistical difference of ES before and after treatment in all cases (P＞0.05).The factors of US7 were positively correlated with DAS28,C-RP and ESR in different extent.Condusion US7 is a viable tool for examining patients with RA.