ObjectiveTo systematically evaluate the efficacy and safety of omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy. MethodsThis study was conducted according to the PRISMA guideline. English and Chinese databases including CNKI， Wanfang Data， VIP， CBM， the Cochrane Library， PubMed， Embase， and Web of Science were searched for clinical studies on omental wrapping technique for pancreaticojejunal anastomosis in preventing complications after pancreaticoduodenectomy published up to November 2022， and Stata 16 and Review Manager 5.4 were used to perform the meta-analysis. ResultsA total of 15 studies with 1 830 patients were included in this study. The meta-analysis showed that the omental wrapping group had a significantly lower overall incidence rate of postoperative pancreatic fistula （POPF） than the non-omental wrapping group （odds ratio ［OR］=0.30， 95% confidence interval ［CI］： 0.22‍ ‍—‍ ‍0.41， P<0.001）， and the subgroup analysis showed that the omental wrapping group had a significantly lower incidence rate of grade B/C POPF than the non-omental wrapping group （OR=0.29， 95%CI： 0.21‍ ‍—‍ ‍0.39， P<0.001）. Compared with the non-omental wrapping group， the omental wrapping group had significantly lower incidence rates of postoperative bile leakage （OR=0.30， 95%CI： 0.16‍ ‍—‍ ‍0.56， P<0.001）， postoperative hemorrhage （OR=0.35， 95%CI： 0.24‍ ‍—‍ ‍0.53， P<0.001）， delayed gastric emptying （OR=0.45， 95%CI： 0.31‍ ‍—‍ ‍0.64， P<0.001）， abdominal infection （OR=0.55， 95%CI： 0.40‍ ‍—‍ ‍0.75， P<0.001）， reoperation （OR=0.31， 95%CI： 0.18‍ ‍—‍ ‍0.54， P<0.001）， and death within 30 days after surgery （OR=0.42， 95%CI： 0.22‍ ‍—‍ ‍0.80， P=0.009）， a significantly earlier time to diet （mean difference ［MD］=-0.98， 95%CI： -1.84 to -0.11， P=0.03）， and a significantly shorter length of postoperative hospital stay （MD=-2.44， 95%CI： -4.10 to -0.77， P=0.004）. There were no significant differences between the two groups in the time of operation （MD=-13.68， 95%CI： -28.31 to -0.95， P=0.07） and intraoperative blood loss （MD=-17.26， 95%CI： -57.55 to -23.03， P=0.40）. ConclusionOmental wrapping can reduce the incidence rates of postoperative complications such as pancreatic fistula， bile leakage， postoperative hemorrhage， abdominal infection， and delayed gastric emptying， improve the prognosis of patients， and shorten the length of hospital stay， without increasing surgical difficulty or time of operation.

Objective To investigate the pathological damage to and inflammation of different intestinal segments in a rat model of severe hemorrhage,and to explore the effect of polarization of intestinal macrophage on the pathophysiology of intestinal inflammation.Methods Male Wistar rats were randomly divided into two groups:the sham operation group and hemorrhage group.In the hemorrhage group,40％of the total blood volume was lost in 25-30 minutes,while in the sham operation group,only the femoral artery and vein were intubated without bleeding.The rats were killed at 0,3,6,12 and 24 hours.The entire intestine was isolated quickly,and sections of the intestine were cut at the duodenum,jejunum,ileocecal junction,colon and rectum for histopathological evaluation.ELISA was adopted to determine related inflammation factors while multi-color immunohistochemistry was used to calculate macrophage surface markers.The data was statistically analyzed.Results(1)Compared with the sham group,there was no significant difference in colon histology at 3 h and 6 h,but significant difference was detected in rectum scores only at 24 h.The scores of other intestinal segments were significantly different at each time point.The severity of ileocecal and colonic lesions after bleeding increased with time.The duodenum,jejunum and ileocecum were more critically injured at 3 h than the rectum at 6 h.The injury to the duodenum,jejunum,ileum and colon was much more pronounced than to the rectum at 12 h.(2)The expressions of TNF-α and IL-1β in the rectum were increased significantly at 12 h post operation.The expressions of IL-1β,TNF-α in the jejunum increased obviously at 3 h and 6 h,respectively.(3)Three hours after severe bleeding,the level of macrophages in the jejunum and ileocececal area increased significantly,and the percentage of M1 macrophages was higher.After 6 hours,the proportion of M2 macrophages in the jejunum and M1 macrophages decreased significantly.After 3 hours,the percentage of M1 macrophages in the colon decreased,but that of M2 macrophages increased.The proportion of M2 polarized macrophages in the duodenum and rectum increased at 3 h after severe bleeding but decreased at 6 h.Conclusion Pathological damage to intestinal sections after bleeding varies depending on the time,and is correlated with the inflammatory level of macrophages.

Objective To investigate the expression and clinical significance of LINC00638 in colon cancer,and further to explore the impact of LINC00638 on the biological function of colon cancer cells.Methods The cancer genome atlas(TCGA)database was used to preliminarily compare the expression differences of LINC00638 in normal colon tissue and colon cancer tissue,and to explore the rela-tionship between LINC00638 and clinical pathological characteristics of patients.Kaplan-Meier survival analysis was used to further in-vestigate the effect of LINC00638 expression on the prognosis of colon cancer patients.The GEPIA database and the Gene Expression Om-nibus(GEO)database were used to further validate the effect of LINC00638 expression on the prognosis of colon cancer patients.Univari-ate and multivariate COX regression analysis were used to explore the effect of LINC00638,clinical and pathological related factors on the prognosis of colon cancer patients.Small interfering RNA(siRNA)was used to silence the expression of LINC00638 in HCT116 cells and DLD1 cells,and the effect of LINC00638 on the proliferation,migration and invasion of colon cancer cell was explored through CCK-8 experiment,colony formation experiment,scratch experiment and Transwell experiment.Results The expression level of LINC00638 was significantly increased in colon cancer tissue,and its expression level was closely related to lymph node metastasis and TNM staging in co-lon cancer patients.The results of Kaplan-Meier survival curve analysis showed that the higher the expression level of LINC00638,the worse the prognosis of colon cancer patients(P＜0.05).The results of COX regression analysis showed that LINC00638,age,and TNM staging could be independent prognostic factors for colon cancer patients.The results of cell function experiments showed that compared with the control group,the proliferation,migration,and invasion ability of cells in knockdown group were significantly decreased(P＜0.05).Conclusion LINC00638 is highly expressed in colon cancer,and the higher its expression level,the worse the prognosis of colon cancer patients.After knocking down LINC00638,it can inhibit the proliferation,migration and invasion ability of colon cancer cells.

Objective Based on the gene expression omnibus(GEO)database,bioinformatics methods were employed to analyze the expression characteristics of hypoxia-related differentially expressed genes(HRDEGs)in ischemic stroke,and key genes were screened,to provide important support for a deeper understanding of ischemic stroke.Methods The GSE16561 and GSE58294 datasets were downloaded from the GEO database,and Python software was used for data integration.The Combat method was employed to eliminate batch effects while retaining disease grouping characteristics.Principal component analysis was conducted to reduce dimensionality of the data before and after batch effect removal,and intraclass correlation coefficient(ICC)testing was performed on the ischemic stroke and normal control groups.Gene set enrichment analysis(GSEA)and single-sample GSEA were conducted on the merged and batch effects eliminated dataset,with a nominal P-value(NOM P-val)＜0.05 and false discovery rate P-value(FDR P-val)＜0.25 used as criteria to select significantly different gene sets.Differential expression genes between the ischemic stroke samples and normal control samples after merging and eliminating batch effects of the GSE16561 and GSE58294 datasets were identified using R software,with an absolute value of log2 gene expression fold change(FC)≥0.58 and adjusted P-value(Padj)＜0.05 as selection criteria.Intersection with hypoxia-related genes obtained from the National Center for Biotechnology Information(NCBI)in the United States yielded the HRDEGs.Gene ontology(GO)and Kyoto encyclopedia of genes and genomes(KEGG)enrichment analyses were performed on the HRDEGs,and the STRING database was used to construct a protein-protein interaction network of differentially expressed genes.The top 10 key genes were filtered using Cytoscape 3.8 software.Results The ICC analysis results showed excellent consistency in the ischemic stroke and normal control samples after batch effect removal,with ICC values of 0.94 and 0.98 for the GSE16561 and GSE58294datasets,respectively.GSEA results demonstrated significant enrichment of 34 gene sets in the stroke samples in the newly merged and batch effects removed dataset from GSE16561 and GSE58294,leading to the identification of 404 differentially expressed genes(all with Padj＜0.05),including 354 upregulated genes and 50 downregulated genes.Intersection with hypoxia-related genes yielded 64 HRDEGs.GO enrichment analysis indicated significant enrichment of HRDEGs in vesicle lumen,cytoplasmic vesicle lumen,secretory granule lumen,with molecular functions such as amide binding,peptide binding,phospholipid binding,and enzyme inhibitor activity.These genes are primarily involved in the positive regulation of cytokine production,regulation of immune response,response to bacterium-derived molecules,and response to lipopolysaccharide,among other biological processes.KEGG enrichment analysis revealed enrichment of HRDEGs in pathways related to lipid and atherosclerosis,Salmonella infection,neutrophil extracellular trap formation,nucleotide-binding oligomerization domain-like receptor signaling pathway,protein glycosylation in cancer,tuberculosis,and necroptosis.Based on the protein-protein interaction network,10 key genes were identified,including arginase1(ARG1),caspase1(CASP1),interleukin1 receptor type 1(IL-1R1),integrin subunit alpha M(ITGAM),matrix metalloproteinase9(MMP9),prostaglandin-endoperoxide synthase 2(PTGS2),signal transducer and activator of transcription 3(STAT3),Toll-like receptor2(TLR2),TLR4,and TLR8.Conclusion This study has identified 10 key genes associated with ischemic stroke and hypoxia through bioinformatics mining,which maybe provid potential targets for subsequent research and diagnostic and therapeutic interventions.

Objective:To investigate the unqualified hepatitis C virus (HCV) detection result of blood donors from the served area of blood institutions.Methods:The data related to HCV markers detected of the first and repeat blood donors were collected from the system of practice comparison for the Chinese mainland blood institutions from 2017 to 2021. The anti-HCV reactive rate and the rates of anti-HCV negative but HCV-RNA reaction and all the relationship between rates and the annual, regional and different blood donors were statistically analyzed.Results:During 2017-2021, the number of anti-HCV reactive per 100 000 blood donors decreased from 444.3 to 250.44 in the served area of 22 blood institutions ( χ2=49.677, P<0.05). The number of HCV RNA detected positive per 100 000 anti-HCV negative increased from 0.69 to 2.05 year by year, but there was no statistical significance ( χ2=0.643, P>0.05). The anti-HCV unqualified rate was significantly different among regions ( χ2=3 260.283, P<0.05). The anti-HCV unqualified rate of the first blood donors was significantly higher than that of the repeated blood donors ( F=130.993, P < 0.05). The annual number of HCV RNA detected positive per 100 000 anti-HCV negative blood samples from donors ranged from 0 to 17.28. Conclusions:The anti-HCV unqualified rate of blood donors in the served area of 22 blood institutions decreased year by year. Compared with repeated blood donors, HCV infection should be emphasized in first-time blood donors. The implementation of HCV RNA test can detect out much more HCV infections and reduce the risk of transfusion transmitted infectious HCV.

Objective:To analyze the clinical characteristics and pathogenic distribution of severe pneumonia in adults in order to provide basis for clinical diagnosis and treatment.Methods:From June 2021 to April 2022, 145 patients with pneumonia admitted to the Department of Respiratory and Critical Care Medicine of the Second People's Hospital of Guangdong Province. According to whether they meet the diagnostic criteria for severe pneumonia, they were divided into severe ( n=63) and mild ( n=82) groups, and the clinical features between the two groups were compared. At the same time, the role of FilmArray detection in severe pneumonia was discussed. The measurement data were tested using independent sample t test or Mann-Whitney U test, and the counting data were tested using Chi-square test or Fisher exact probability method. Results:The age of the patients in the severe group was (72.67±1.71) years, male patients accounted for 84.1%, and the median hospitalization time was 16 days. Nine patients died in hospital; most of them had fever, shortness of breath, and change of consciousness, accompanied by hypertension, diabetes, cerebrovascular disease, chronic kidney disease, and tumor history. Compared with the mild group, the total number of leukocytes, neutrophil ratio, procalcitonin, and C-reactive protein were higher in the severe group, but the CD3 +, CD4 +, and CD8 + cell counts were lower ( P<0.05). The positive rate of FilmArray detection in the severe group was 81%, and the mixed infection of multiple bacteria accounted for 50%, which was higher than that of traditional culture ( P<0.05). The top four pathogens in severe group were Pseudomonas aeruginosa, Acinetobacter baumannii complex, Klebsiella pneumoniae, and Staphylococcus aureus, which were significantly higher than that in the mild group ( P<0.05). Resistance genes were detected in patients with severe disease, which was significantly higher than that in patients with mild disease (70.7% vs. 17.5%, P<0.05). Conclusions:Severe pneumonia is more common in elderly men, with more basic diseases and poor immunity. FilmArray has a high positive rate and can detect multiple pathogens, which may have a role in the rapid diagnosis of severe pneumonia.

Objective:To evaluate the prognostic value of preoperative red cell distribution width to platelet ratio on prostate cancer patients treated with endocrine therapy after radical prostatectomy.Methods:The clinical data of 349 prostate cancer patients treated with endocrine therapy after radical prostatectomy in our hospital from October 2007 to October 2018 were retrospectively analyzed.Among all the patients, the average age was 67 years old(ranged 42 to 84 years). The preoperative newly diagnosed PSA level was 4.2-499.2 ng/ml(average 30.6 ng/ml). 158 cases had a Gleason score of more than 8. 191 cases had a Gleason score of below than 8. According to tumorous staging, 151 patients were staged less than or equal to stage T 2b, 110 patients were staged as stage T 2c, 88 patients were staged equal or greater than stage T 3a. 295 patients were staged less than 1.15 ng/(ml·cm 3)of prostate specific antigen density, 54 patients were staged equal or greater than 1.15 ng/(ml·cm 3). There were 86 cases of seminal vesicle invasion and 263 cases of non-seminal vesicle invasion. There were 121 patients with low risk of prostate cancer, 83 patients with medium risk, and 145 patients with high risk. All patients received endocrine therapy after radical prostatectomy with androgen deprivation therapy (ADT). End point of observation was biochemical recurrence-free survival (RFS) with PCa patients treated with endocrine therapy after radical prostatectomy. Patients were categorized in two groups with high RPR and low RPR values using a cut-off point as calculated by the receiver-operating curve analysis.Correlations between RPR and clinical characteristics were analyzed.The prognostic analysis of preoperative RPR on prostate cancer patients treated with endocrine therapy after radical prostatectomy was estimated using Kaplan-Meier analysis and Cox proportional hazards models. Kaplan-Meier method was used to draw the survival curve. Meanwhile, univariate and multivariate Cox regression were used to explore factors influencing the prognosis of PCa patients. Results:of the 349 cases, ranging 4-132 months. Biochemical recurrence with PCa patients occurred in 93 cases, and 256 patients were not biochemical recurrence.The ideal cutoff value of preoperative RPR was 0.27(95% CI 0.502-0.653, P<0.05)determined by the ROC curve, by which the 349 patients was divided into the high RPR group of 66 patients(18.9 %) and the low RPR group of 283 patients(81.1 %). Preoperative RPR was significantly associated with Gleason score ( P=0.005), newly diagnosed tPSA value ( P=0.000), tumor T stage ( P=0.031), PCa risk scale ( P=0.037), positive margin ( P=0.030). The RFS in the high RPR group(26.0 months)was shorter than that in the low RPR group(35.0 months)( P<0.001). In univariate analysis, Gleason score ( HR=1.579, 95% CI 1.049-2.376, P=0.028), serum newly diagnosed tPSA ( HR=2.979, 95% CI 1.655-5.362, P=0.000), tumor T stage( HR=1.292, 95% CI 1.009-1.653, P=0.042), preoperative RPR value ( HR=3.555, 95% CI 2.339-5.401, P=0.000) were prognostic factors ( P<0.05). Cox multivariate analysis showed that higher newly diagnosed tPSA value( HR=1.917, 95% CI 1.033-3.558, P=0.039)and higher RPR value( HR=3.086, 95% CI 1.994-4.775, P=0.000) were independent predictors for endocrine therapy after radical prostatectomy of PCa( P<0.05). Conclusions:Preoperative RPR was an independent predictor for poor prognosis in PCa patients treated with endocrine therapy after radical prostatectomy.

With the promotion of the concept of minimally invasive surgery, hepatobiliary surgery has gradually become a mainstream technique; however, for bile duct tumors in the perihilar region, there are few reports on the application of laparoscopy in such tumor due to the complex structure and anatomical variations of the hepatic hilar region. With reference to related reports in China and globally, this article introduces the research advances in the application of laparoscopy in perihilar tumor surgery. The analysis shows that laparoscopy has certain advantages in the surgical treatment of perihilar tumors, especially in the treatment of Bismuth Ⅰ/Ⅱ hilar cholangiocarcinoma and early-stage gallbladder cancer; due to the high requirements of laparoscopic surgery for the surgeon, only a few experts can perform this surgery at present, and strict screening and evaluation of patients are also required. Therefore, laparoscopy used in perihilar tumor surgery is still at the preliminary stage of exploration, with a need for further exploration and learning.

Objective:To understand the iodine nutritional status of key population and its correlation with water iodine and salt iodine in Hainan Province, and to provide scientific basis for iodine supplement.Methods:According to the "National Water Iodine Content Survey Program for Drinking Water" and the "National Iodine Deficiency Disorders Surveillance Program (2016)", surveys on water iodine and iodine nutritional status of key populations in 21 cities (counties, districts) in Hainan Province in 2017 and 2018 were conducted. Water samples, urine samples at random and home salt samples of children aged 8 - 10 years old and pregnant women were collected to detect water iodine, urinary iodine and salt iodine. At the same time, the thyroid volume of children was measured by B-mode ultrasound, and the goiter rate was calculated. According to the geographical location, Hainan Province was divided into 3 areas: central mountainous, western coastal and eastern coastal, the results of water iodine, salt iodine and urinary iodine in different areas were compared and analyzed. Water iodine was detected by "Water Iodine Detection Method Suitable for Iodine Deficiency and High Iodine Areas" recommended by National Reference Laboratory for Iodine Deficiency Disorders; urinary iodine was detected by arsenic cerium catalytic spectrophotometry; salt iodine was detected by direct titration.Results:A total of 2 566 water samples were detected, and the median water iodine was 6.0 μg/L. A total of 4 220 urine samples of children were detected, the median urinary iodine was 170.0 μg/L (appropriate range was 100 - 199 μg/L), the goiter rate was 0.09% (4/4 220). A total of 2 124 urine samples of pregnant women were detected, the median urinary iodine was 120.7 μg/L (appropriate range was 150 - 249 μg/L). A total of 6 344 salt samples were detected, coverage rate of iodized salt, qualified rate of iodized salt and consumption rate of qualified iodized salt were 97.76% (6 202/6 344), 97.47% (6 045/6 202), and 95.29% (6 045/6 344), respectively. In central mountainous, western coastal and eastern coastal areas, medians water iodine were 3.3, 6.5, and 6.5 μg/L, respectively, the difference was statistically significant ( H = 13.721, P < 0.01); the consumption rates of qualified iodized salt were 97.86% (1 833/1 873), 90.52% (1 613/1 782), and 96.65% (2 599/2 689), respectively, the difference was statistically significant (χ 2 = 71.217, P < 0.01); the medians urinary iodine of children were 182.4, 160.1, and 167.4 μg/L, respectively; the medians urinary iodine of pregnant women were 120.1, 117.7, and 103.9 μg/L, respectively. There was a positive correlation between urinary iodine in children and pregnant women and salt iodine ( r = 0.394, 0.657, P < 0.05). Conclusions:The iodine nutrition of children in Hainan Province is generally at an appropriate level, and pregnant women are at risk of iodine deficiency. There is a positive correlation between urinary iodine in children and pregnant women and salt iodine. The prevention and treatment of iodine deficiency disorders should focus on strengthening iodine nutrition monitoring of pregnant women.

Objective To grasp the distribution of iodine in drinking water in the environment of Hainan Province,and provide scientific basis for prevention and treatment of iodine deficiency disorders.Methods In 2017,in all cities (counties,districts) in Hainan Province,townships were used as units to collect water samples to detect iodine content according to their different water supply methods.In the townships with median drinking water iodine ＞ 10 μg/L,the administrative village (neighborhood committee) was used as a unit to collect water sample to detect iodine content.According to the geographical location (central mountainous area,eastern coast,western coast),water source type (tap water,intubation well,spring water),and well depth,the distribution of water iodine was analyzed.Results A total of 2 566 water samples were detected in 21 cities (counties,districts),the median water iodine was 6.0 μg/L,range was 0.1-150.6 μg/L,the median water iodine of all cities (counties,districts) was ＜ 10 μg/L.The median water iodine in the central mountainous area,eastern coast,and western coast were 3.3,6.5,6.5 μg/L,respectively;tap water,intubation well,and spring water were 5.6,6.4,1.3 μg/L,respectively;0-,100-,200-,≥300 m well depth were 6.6,5.1,4.2,and 1.5 μg/L,respectively.The water iodine content range was 0.2-17.9 μg/L in 230 townships in the province,there were 12 townships with the median water iodine ＞ 10 μg/L,including 133 administrative villages (neighborhood committees),and 737 water samples were detected,the water iodine content range was 1.0-37.1 μg/L.Conclusions All cities (counties,districts) in Hainan Province belong to iodine deficiency areas,the central mountainous area is even more serious.Most of the townships in the province are in iodine deficiency.No administrative villages (neighborhood committeea) with high iodine have been found.The province should continue to implement salt iodization to prevent and treat iodine deficiency disorders.