Objective:To explore the feasibility of anastomosis between bladder and intestine of experimental rabbit by drag anastomosis.Methods:In this study 40 Japanese big-eared rabbits were randomly divided into two groups through random number table, the experimental group and the control group, each group with 20 rabbits. In the experimental group, the bladder neck was fixed to the catheter and then the catheter was drawn outward. With the traction of the catheter, the bladder neck was anastomosed with the distal intestinal tube by means of suture free. The control group was anastomosed by regular interrupted suture of bladder and intestine. The operation time, anastomosis time, intraoperative blood loss, postoperative urinary leakage rate and postoperative anastomotic healing of rabbits in the two groups were compared.Results:The operation time of the experimental group was shorter than that of the traditional interrupted suture anastomosis group [(33.26±2.79)min vs. (35.25±1.83)min, P=0.014]. The anastomosis time of the experimental group was significantly shorter than that of the traditional interrupted suture anastomosis group[(7.55±1.2)min vs. (8.65±1.03 min), P=0.005]. The intraoperative blood loss in the experimental group was similar to that in the control group[(6.47±2.41) ml vs. (6.75±1.83) ml, P=0.691]. The event of contrast media extravasation occurred in 2 of the 10 experimental rabbits after receiving cystography in the experimental group, and the urinary leakage rate was 20%(2/10). In the control group, contrast media extravasation occurred in 1 of the 9 experimental rabbits after receiving cystography, and the urinary leakage rate was 11.1%(1/9), and the difference of the two groups was not statistically significant ( P=0.348). Anastomotic healing score was (2.0±0.7) in the experimental group, and (2.1±0.74) in the control group ( P=0.767). Conclusions:The bladder-intestine drag-and-bond anastomosis technique, with significantly shorter anastomosis time, was feasible, easy and convenient. Our research provides an experimental and theoretical basis for the clinical application of drag-and-bond anastomosis technique in clinic.

Objective:To summarize the best evidence for early enteral nutrition support in postoperative patients with gastric cancer and evaluate its effectiveness.Methods:From March to August 2021, 108 postoperative patients with gastric cancer admitted to the Gastrointestinal Surgery of the First Affiliated Hospital of Ningbo University were selected. We applied evidence-based nursing methods to summarize the best evidence for early enteral nutrition support in postoperative gastric cancer patients, and constructed and implemented the best evidence application strategy through baseline review, evaluation of evidence application clinical scenarios and barriers. We compared the various indicators of two groups of patients before the application of evidence (March to May 2021, n=55) and after the application of evidence (June to August 2021, n=53) . Results:No adverse events occurred during the application of evidence. After applying evidence, the correct nutritional assessment rate increased from 41.82% (23/55) at baseline review to 90.57% (48/53), the implementation rate of early postoperative enteral nutrition increased from 0 to 45.28% (24/53), the start time of postoperative enteral nutrition shortened from (3.75±2.33) days to (2.06±1.38) days, and the implementation rate of postoperative priority oral nutrition increased from 63.64% (35/55) to 86.79% (46/53), nutritional related complications decreased from 40.00% (22/55) to 20.75% (11/53), and the differences were all statistically significant ( P<0.05) . Conclusions:The application of the best evidence for early enteral nutrition support in postoperative gastric cancer patients can shorten the start time of postoperative enteral nutrition, reduce postoperative nutrition related complications, and promote early recovery of patients.

OBJECTIVE： To study the effect mechanism of iridoid glycosides extracted from Scrophularia ningpoensis inhibiting cardiomyocytes apoptosis in myocardial infarction model rats. METHODS： The male Wistar rats were randomly divided into sham operation group， model group and S. ningpoensis iridoid glycosides low-dose， medium-dose and high-dose groups， with 10 rats in each group. Myocardial infarction models were established by ligating the left anterior descending coronary artery of the rats， and sham operation group was only threaded without ligation. After the model was established， each administration group was given S. ningpoensis iridoid glycosides suspension intragastrically at three different doses of 50，100，200 mg/kg （by the amount of total glycosides extract） with 10 mL/time， twice a day， for consecutive 7 days. Sham operation group and model group were given constant volume of normal saline intragastrically with same method. The changes of S-T segment of lead ECG Ⅱ were recorded before， after and during 7 days of administration. Cardiac function of rats was examined. The serum levels of LDH， CK-MB， cTnⅠ， NT-pro BNP and TNF-α were determined by colorimetry， immunosuppression or ELISA. The apoptosis of myocardial cells was observed by TUNEL method. SOD activity and MDA content in cardiac myocytes were detected by colorimetry. The expressions of Bcl-2， Bax， Cyt C， Caspase-8， Caspase-9， Caspase-12， Caspase-3 and Calpain in cardiac myocytes were detected by ELISA， enzymolysis colorimetry or enzymatic fluorescence assay. RESULTS： Compared with sham operation， electrocardiogram S-T segment was significantly elevated and the left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly increased in the model group； left ventricular ejection fraction and short axis shortening rate decreased significantly； serum levels of LDH， CK-MB， cTnⅠ， NT-pro BNP and TNF-α were increased significantly； there were a large number of yellow-brown apoptotic cells in myocardial tissue； the activity of SOD in myocardial tissue was significantly decreased while the content of MDA was significantly increased； the protein expression level of Bcl-2 and Bcl-2/Bax were significantly decreased， while the levels of Bax， Cyt C， Caspase-3， Caspase-8， Caspase-9， Caspase-12 and Calpain were significantly increased （P＜0.05 or P＜0.01）. Compared with model group， above indexes and pathological changes of myocardial tissue were improved significantly in administration group； the level of Bcl-2 and Bcl-2/Bax in cardiomyocytes increased significantly， while the levels of Bax， Cyt C， Caspase-3， Caspase-8， Caspase-9， Caspase-12 and Calpain decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS： S. ningpoensis iridoid glycosides can inhibit the activation of Caspase-3 by inhibiting three apoptotic pathways related to Caspase-8， Caspase-9 and Caspase-12， and then inhibit the apoptosis of cardiomyocytes.

Objective To determine the radiographic feasibility of oblique lumbar interbody fusion (OLIF) corridor to treat lumbar disease at each lumbar disc level,including the corridor's numerical value and the influence of diaphragmatic crura and aorta abdominalis.Methods A retrospective CT study was conducted on 110 patients (including 69 males and 41 females,average age 47.95 years,range 16-83 years) that continuously collected and analyzed in the PACS system.The oblique corridor was defined as the area between the left lateral border of the aorta abdominalis(or iliac artery) and the right lateral border of the left psoas.The distances and angles of L1-2,L2-3,L3-4 and L4-5 levels were measured.Whether the change of diaphragmatic crura and aorta abdominalis affected the building of the corridor was also observed.Results The mean distances of oblique corridor to the levels of L1-L5 discs were:L1-2 15.90 mm,L2-3 14.82 mm,L3-4 17.57 mm,L4-5 11.16 mm.At the levels of L1-2 and L3-4,all of the images could build the corridor.But there were only 97.27％ images allowing operation at both L2-3 and L4-5,and the other 3 cases couldn't build the corridor since the aorta abdominalis was very close to psoas,and the distance was almost 0 mm.The max mean distance was 36.79 mm at L3-4 level.The mean angles were:L1-2 36.98°;L2-3 37.76°;L3-4 40.96°;L4-5 37.85°.The significant difference was at L3-4,ranged from 13.09 to 61.93°.The level of the aortic bifurcation was from the lower third of the L3 vertebral body to the middle third of the L5 vertebral body.The levels of left diaphragmatic crura's ending point in the lumbar was divided into four groups:1) Group L1 vertebral body level:the level at L1 vertebral body and above,5 cases (4.55％);Group L1-2 disc to L2 vertebral body level:at L1-2 disc and L2 vertebral body,67 cases (60.91％);Group L2-3 disc to L3 vertebral body level:at L2-3 disc and L3 vertebral body,36 cases (32.72％);Group L3-4 disc to L4 vertebral body level:at L3-4 disc and L4 vertebral body,2 case (1.81％).Conclusion The OLIF corridor can be built successfully at L1-2 and L3-4.However,it may be difficult at L2-3 and L4-5 for some patients due to the aorta abdominalis which is too close to psoas.The angles of L1-L5 levels were similar.While the left diaphragmatic crura was mainly impact the corridor insertion at L1-2 and L2-3.And the level of the aortic bifurcation was mainly located at the upper endplate of L4 to the L4-5 disc (87％).

Objective To investigate the serum γ-glutamyl transferase(γ-GT)level and its clinical significances in hepatitis B virus(HBV)-liver failure(LF)patients.Methods γ-GT levels were detected in 89 LF patients,30 cases with cirrhosis and 30 healthy controls.Difference of serum γ-GT between survival group and death group in LF patients and dynamics of γ-GT after hospitalization were studied. Survival rate between γ-GT increase group and decrease group were compared.The associations of γ-GT with model for end stage live disease(MELD)and prealbumin were calculated.Results At baseline,the γ-GT levels in LF,cirrhosis and healthy control groups were(149.61 ± 69.86),(123.96 ± 59.52)and (48.28 ± 10.25)U/L,respectively,the difference among groups was significant(F= 178.150,P<0.05).The survival group in LF patients showed significant increase of γ-GT one week after hospitalization compared with death group([75.27 ± 10.34]vs[29.47 ± 5.05],t=5.40,P<0.05). The γ-GT increase group showed higher survival rate than γ-GT decrease group[76.19%(48/63)vs 23.08%[6/26],χ2=21.76,P<0.05].Serum γ-GT level in LF patients was positively correlated with both MELD score and prealbumin(r=0.709 and -0.627,respectively,both P<0.05).Conclusions The rise of γ-GT may indicate a better prognosis in LF patients.Serum γ-GT positively correlates with prealbumin and both could reflect the regeneration of hepatocytes.

Objective: To summarize the preliminary experience with transoral endoscopic thyroidectomy via vestibular approach (TOETVA). Methods: A total of 150 consecutive patients with thyroid disease underwent TOETVA from November 2014 to February 2017 at Department of Thyroid Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine. The patients were comprised of 138 females and 12 males. The mean age of the patients was (31.7±7.6) years (ranging from 15 to 51 years). There were 108 patients of differential thyroid carcinoma (T1 or T2 ≤3 cm, cN0 or cN1a, M0) and 42 patients of benign thyroid disease (solid nodule ≤6 cm). The criteria analyzed were clinicopathologic characteristics, types of operation, operation time, complications and results of follow-up. Results: Two cases were converted into open surgery due to an incredible unexpected tumor size and tracheal invasion, respectively. One hundred and three patients with papillary carcinoma underwent transoral central neck dissection (CND), with the mean operation time of (146±34) minutes for hemithyroidectomy with CND, and (187±36) minutes for total or near total thyroidectomy with CND. The mean number of lymph node yields was 8.2±4.7, and the lymph node metastasis rate was 41.7% (43/103). Regarding postoperative complications, transient hoarseness occurred in 3 patients, and permanent recurrent laryngeal nerve occurred in 2 patients. One patient had local infection or transient mental nerve palsy. Transient hypocalcemia occurred in 31.8% of 22 patients who underwent total, near-total, or subtotalthyroidectomy, and no permanent hypocalcemia was registered. Mean hospital stay after operation was (3.5±0.6) days (ranging from 2 to 5 days). Mean follow-up period was (11.5±7.8) months (ranging from 1 to 28 months), no recurrence or metastasis occurred. Conclusions TOETVA is feasible and safe for strictly selective patients. It brings perfect cosmetic effect. Long-term follow-up and further study is needed to assess its curative effect.

Objective To imitate the pathological process of bronchiolitis obliterans(BO) post lung transplantation and in-vestigate the phenomenon of epithelial-mesenchymal transition ( EMT ) in small airway epithelial cells and its relation to BO . Methods We established the rat model of allogeneic orthotropic left lung transplantation with grafts from F 344 rats transplanted to Lewis rats by the Tri-cuff anastomosis.Then rats were daily injected intraperitoneally with cyclosporine (5 mg· kg-1 · d-1 ) for 10 days, intratracheally applied with lipopolysaccharide(0.5 mg/kg) at the 28th day and killed at the 90th day post-surger-y.We observed the histological structure of the lung grafts by HE and Masson staining , detected E-cadherin and Vimentin ex-pression in lung grafts and normal ones of F344 rats by immunohistochemistry, then analyzed the relation between small airway remodeling and the alterations in EMT markers expression .Enumeration data was analyzed with Fisher exact test and Spearman rank correlation was applied in correlation analysis .Results We found inflammatory cell infiltration , fibroplasia of bronchiole walls and significant lumen stenosis in lung graft mesenchyma.In lung grafts, the positive expression of E-cadherin was 5(total 13), which was significantly lower than that in normal lungs(7/8, P<0.05), and conversely the positive expression of Vim-entin was higher than normal ones(10/13 vs 2/8, P <0.05).The Spearman rank correlation analysis demonstrated that E-cadherin expression bear a negative correlation with Vimentin expression(r=-0.750, P<0.01).Conclusion Our study established a disease model imitating the pathological process of BO .And EMT was observed in small airway epithelial cells of the BO-exhibited lung grafts, indicating that EMT was involved in the process of BO airway remodeling .Thus it may reveal no-vel therapeutic targets for BO post lung transplantation by further investigation into the mechanism and pathological significance of EMT in small airway epithelial cells.

OBJECTIVETo summarize the experiences of applying three-dimensional (3D) technique in scarless endoscopic thyroidectomy (SET) via anterior chest approach.

METHODSMedical records of patients who undenvent SET using 3D technique from December 2013 to May 2014 were retrospectively reviewed. A total of 32 patients who had a preoperative ultrasound-guided fine-needle aspiration cytology diagnosis of unilateral papillary thyroid carcinoma and underwent lobectomy associated with central lymph node dissection were included in this study. All patients were female with a mean age of (37 ± 10) years at diagnosis. In addition, 45 female patients who underwent traditional endoscopic thyroidectomy at the same period were randomly selected as control.

RESULTSAll surgical procedures were successfully finished. The mean surgical time in 3D group was (91. 7 ± 11. 4) minutes, and mean hospitalization time was (3. 2 ± 0. 5) days. Contemporary hoarseness was observed in one patient, and no bleeding, infection, hypocalcemia and other postsurgical complications were observed. Compared to the traditional endoscopic surgery group, 3 D group had significantly shorter surgical time of lobectomy ((23. 2 ± 5. 1) minutes vs. (28. 0 ± 5. 0) minutes, t = 4. 156, P = 0. 000). Negative results were seen in the time taking of creating surgical space ((14. 6 ± 3. 3) minutes vs. (15. 6 ± 2. 5) minutes), central lymph node dissection ((25. 1 ± 5. 4) minutes vs. (24. 4 ± 6. 3) minutes) and total surgical time ((91.7 ± 11. 4) minutes vs. (96. 1 ± 13. 0) minutes).

CONCLUSIONApplication of 3D technique in endoscopic surgery can offer 3D vision of the surgical field, thus significantly shorten lobectomy time and more easily to achieve fine dissection and functional protection of recurrent laryngeal nerves, parathyroids and other vital anatomic structures.

Adult ; Biopsy, Fine-Needle ; Carcinoma ; diagnosis ; surgery ; Carcinoma, Papillary ; Endoscopy ; methods ; Female ; Humans ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Operative Time ; Retrospective Studies ; Thyroid Neoplasms ; diagnosis ; surgery ; Thyroidectomy ; methods

A total of 105 patients with first-episode schizophrenia (male =51,female =54) and 99 normal controls (male =51,female =48) were included into this retrospective case-control study.Childhood trauma questionnaire-28 item short form (CTQ-SF) was used to assess the experience of childhood abuse.The result of binary logistic regression showed that emotional abuse (β =0.630,P ＜ 0.05) and emotional neglect(β =0.270,P ＜ 0.05) were included into the final model of predicting schizophrenia.It indicates that patients with first-episode schizophrenia experienced more early life stress than controls.Particularly emotional abuse and emotional neglect may play important roles in the onset of schizophrenia.

BACKGROUND:How to obtain a sufficient number of cells is one of the key issues in the celltransplantation therapy, and studies have shown that stem cellproliferation can be promoted by reasonable stimulus.
OBJECTIVE:To investigate reduced glutathione effects on biological characteristics of human umbilical cord blood mesenchymal stem cells.
METHODS:The cells were divided into two groups:the control group consisted of the normal human umbilical cord blood mesenchymal stem cells, and in the experimental group, human umbilical cord blood mesenchymal stem cells were treated with 0.15 g/L reduced glutathione.
RESULTS AND CONCLUSION:At days 5, 7, 9, cells treated with 0.15 g/L reduced glutathione showed higher absorbance values than those in the control group (P<0.05). Flow cytometry showed reduced glutathione had no effects on CD29, CD44, CD45, CD105 expression. Real-time PCR results showed reduced glutathione was capable of promoting extracellular signal-regulated kinase mRNA expression (P<0.05). Findings from this study showed that 0.15 g/L reduced glutathione can promote the proliferation of human umbilical cord blood mesenchymal stem cells.