Objective:To analyze the short-term clinical outcomes of total laparoscopic distal gastrectomy (TLDG) and laparoscopic-assisted distal gastrectomy (LADG) combined with Billroth-Ⅱ+Braun anastomosis.Methods:Clinical characteristics of patients undergoing laparoscopic distal gastrectomy combined with Billroth-Ⅱ+Braun anastomosis at Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from Jan 2020 to Oct 2022 were analyzed. Patients were divided into TLDG group ( n=62) and LADG group ( n=62) according to the surgical approach. Results:There were significant differences in the preoperative clinical data section between the two groups, and 124 patients (62 in each group) were enrolled after using propensity score matching to balance significant variables. Compared with the LADG group, the TLDG group showed statistically differences in time to first venting [(2.9±1.3) vs. (2.3±0.8) d, Z=-3.072, P=0.002], time to first fluid diet [(5.9±1.3) vs. (5.4±1.4) d, Z=-2.031, P=0.042] and incision length [(7.1±1.4) vs. (4.8±0.8) cm, Z=-6.331, P=0.000]. Total postoperative complication rate in the TLDG group and the LADG group (29% vs. 37%, χ2=0.911, P=0.340) was not statistically significant. Incidence of postoperative pneumonia was lower in the TLDG group than in the LADG group (3% vs. 13%, χ2=3.916, P=0.048), and incidence of all remaining postoperative complications were not statistically significant. There was no statistically significant difference in the incidence of serious postoperative complications between the TLDG and LADG groups ( P=1.000). Multifactorial analysis revealed that male ( P=0.023) and age ≥65 years ( P=0.001) were independent risk factors for postoperative complications. Conclusion:TLDG is safe and feasible and has better short-term clinical efficacy than LADG.

Objective:To explore rational surgical treatment for childhood nail matrix nevi.Methods:A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi, who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019. Different surgical approaches were adopted according to the site and width of lesions. For lesions with a width of ≤ 3 mm, the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases. For lesions with a width of > 3 mm, one of the following 3 surgical procedures was selected by the children′s parents: (1) shaving of nail bed and nail matrix lesions under a microscope at ×8 magnification (8 cases) ; (2) excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx (8 cases) ; (3) excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting (5 cases) , or excision of lesions of the thumb followed by abdominal-wall flap transfer (3 cases) . The patients were followed up for 12 months, and clinical efficacy was evaluated.Results:During the follow-up, no recurrence occurred in the 11 cases receiving direct excision and suture, with good appearances and longitudinal linear scars on the nail. Among the 8 cases receiving shaving therapy under a microscope, 4 experienced relapse during the follow-up of 6 - 12 months, and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence. No recurrence was observed in the 8 cases receiving excision of the lesions and full-thickness skin grafting, of whom 1 experienced skin graft necrosis, and skin grafts survived with obvious pigmentation in the other 7 cases. Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer, no recurrence was observed, and all transferred flaps survived; good appearances, nearly normal color and gloss of nails were obtained in the cases after transfer of skin flaps from the thenar muscle area, while the color and gloss of postoperative nails were markedly different from those of normal nails in the cases receiving abdominal-wall flap transfer.Conclusion:For nail matrix nevi with a width of ≤ 3 mm, direct excision and suture with 1-to-2-mm margins are recommended; for those with a width of > 3 mm, excision of lesions combined with full-thickness skin grafting, transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer is recommended; the shaving procedure under a microscope should be used with caution.

Objective To study the distribution and drug resistance of pathogens in patients with lung cancer,and analyze the prevention strategies. Methods A total of 312 cases of lung cancer patients with infection treated in our hospital from January 2017 to January 2021 were selected as the research objects.The lower respiratory tract secretions,urine and feces were collected for pathogen culture and drug sensitivity test;the distribution and drug resistance of pathogens were analyzed,and the corresponding prevention strategies were formulated. Results Of the 312 patients, 165 (52.88%) had respiratory tract infection, 79 (25.32%) had oropharyngeal infection, and 68 (21.80%) had urinary tract infection.The highest proportion was respiratory infection.Among the 312 patients,398 pathogens were detected of which 212 Gram-positive bacterias (53.27%)were found of which Staphylococcus epidermidis(15.58%)and Staphylococcus aureus(13.07%)accounted for a relatively high proportion. Among 175 Gram-negative strains,Klebsiella pneumoniae(15.94%)and E.coli (10.05% ) accounted for a large proportion.The resistance rate of Gram-positive bacteria,such as Staphylococcus epidermidis and Staphylococcus aureus,to amikacin,gentamicin and penicillin,was more than 50%,which was sensitive to vancomycin. Gram negative bacteria such as Klebsiella pneumoniae and E.coli have high resistance to common antibiotics,and the drug resistance rate to cefepime and cefazolin is more than 50%,and sensitive to imipenem/cilastatin and imipenem/cilastatin.Among 11 fungi,4 cases were resistant to fluconazole , 36.36%,3 to itraconazole,27.27%,0 to ketoconazole and voriconazole,0.00%. Conclusion The distribution and drug resistance of pathogenic bacteria in patients with lung cancer infection in our hospital have certain characteristics,in which Gram-positive bacteria are mainly Staphylococcus epidermidis and Staphylococcus aureus,Gram-negative bacteria are mainly Klebsiella pneumoniae and Escherichia coli,and there are also a small number of fungal infections.Therefore,we should strengthen the monitoring of etiology and drug resistance,and strengthen the management of hospital disinfection Drug sensitivity results of patients,rational use of antibiotics,so as to improve the treatment effect and reduce the risk of infection.

Objective: To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) in elderly patients with early-stage mild ischemic stroke (IS). Methods: This was a prospective, open-label, controlled study.Ninety-four elderly patients with mild IS admitted to our hospital from January 2014 to December 2017 were randomized into a thrombolysis arm (TA, n=46) and a control arm (CA, n=48). The short-term endpoints were the National Institutes of Health stroke scale (NIHSS) scores on 3^rd, 7^th, 14^thday after admission and the secondary endpoints were the modified Rankin Scale (mRS) score and the morbidity of recurrence IS within 90 days.Safety was evaluated by the incidence of intracranial hemorrhage (IH) and early neurological deterioration (END) during hospitalization. Results: The baseline NIHSS scores of patients in the TA and CA groups were similar [(4.1±0.7) vs.(4.1±0.7)]. However, there were significant differences in the NIHSS score on 3^rd [(3.4±1.2) vs.(4.2±1.4)], 7^th[(3.0±1.8) vs.(4.1±1.6)] and 14^thday [(2.5±2.0) vs.(3.4±1.6)], respectively, between the TA group and the CA group.Furthermore, the TA group was associated with a significantly higher proportion of patients with good prognosis (mRS, 0-2), compared with the CA group (71.7% vs.35.4%, P<0.01). Receiver operating characteristic curve analysis showed that patients with baseline NIHSS>3 could benefit from thrombolytic therapy.There were 1 case of symptomatic IH and 1 case of progressive stroke in the TA group, and 1 case of IH and 2 cases of progressive stroke in the control group.There were no significant differences in the rate of either END or IH between the two groups (P>0.05). Two patients in the TA group and three patients in the control group had recurrent IS within 90 days and the recurrence rate of IS was also similar within 90 days (P>0.05). Conclusions Intravenous thrombolytic therapy with rt-PA can improve the prognosis of elderly patients with mild stroke without increased risk of END, IH, or recurrence of IS.

At present,the prevalence of diabetic retinopathy (DR) has increased significantly in the world,control and prevention of DR in China also face increasing challenges.DR has become one of the leading causes of blindness among working-aged adults.Screening and early detection is an important step to reduce new blindness resulting from DR.In the meantime,more intensive treatments should be taken to prevent its progression to severe DR.In this paper,we summarize the risk factors that promote the occurrence and development of DR,as well as the methods for DR screening.

Objective To investigate the effects of changes of miR-126 and spouty related EVH,domain containing proteinl(SPRED1) after transient ischemic attack(TIA)on prognostic value for pathogenesis of secondary cerebral infarction.Methods Retrospective analysis of the clinical data of 106 patients with TIA was performed.The expression levels of miR-126,SPRED1 and vascular endothelial growth factor(VEGF)in peripheral blood were detected at 3 h,6 h and 12 h after TIA onset respectively.The specificity and sensitivity of miR 126 and SPRED1 in the diagnosis of TIA were analyzed.The miR-126 and SPRED1 levels versus ABCD2 score were compared for evaluating their predictive value in the diagnosis of secondary cerebral infarction within 30 days after TIA onset.Results The miR-126 level was declined after TIA onset at 3 h(9.41±1.04),especially at 12 h(6.59 ±2.78),versus in healthy control (9.35±1.76)(t =-7.764,P=0.000).The SPRED1 level after TIA onset was increased at 3 h(58.05 ± 17.53)pg/L,12 h(82.64 ± 18.60)pg/L versus in healthy control(52.38 ± 13.24)pg/L(t=12.374,P =0.000).A closely negative correlation was found between levels of miR 126 and SPRED1 at 12 h point but not at 3 h and 6 h(r=-0.278,P=0.004).Both miR-126 and SPRED1 levels at 12 h after TIA were implied to sensitivity and specificity evaluation.Additionally,VEGF was significantly increased at 3 h (345.61 ± 76.76) pg/L,6 h (461.65 ±103.87)pg/L and 12 h (519.22 ± 103.55)pg/L after TIA onset as compared with healthy control (107.77± 26.04) pg/L(t =26.569,29.756,34.699,all P =0.000).The decrease of miR-126 and increase of SPRED1 at 12h after TIA indicated high incidences of cerebral infarction but their significance was less than ABCD2 score.Combination of miR 126,SPRED1 and ABCD2 score significantly improved the prediction for cerebral infarction(Z=2.105,P =0.035).Conclusions After the onset of TIA,levels of miR-126 and SPRED1 expression in combination of ABCD2 score can improve predictive value for cerebral infarction development.

Objective To investigate the value of ischemic modified albumin (IMA) and microRNA-126 (miR-126) in diagnosis of posterior circulation transient ischemic attack (PTIA) and in prediction of secondary cerebral infarction.Methods The clinical materials of 112 patients with PTIA were retrospectively analyzed.Serum IMA and miR-126 levels were measured at 3,6 and 12 h,and the correlation between serum IMA,miR-126 levels and PTIA as well as secondary cerebral infarction was analyzed by ABCD2 score.Results Serum IMA level was (54.19 ± 10.10) U/L in 80 healthy controls,and were (85.81 ±20.21),(62.98 ±12.79),(57.66 ±13.39) U/L at 3,6 and 12 h,respectively,in 112 patients with PTIA.and its levels of miR-126 at 6,12 h after PTIA attack were significantly decreased compared with (9.35 ± 1.76) in the healthy controls(P =0.036,P =0.001).In the patients with PTIA,the level of IMA at 3 h was negatively correlated with the level of miR-126 at 12 h (r =-0.3 13,P =0.0 00).When IMA and miR-12 6 levels were 6 7.5 2 U / L and 8.64,the sensitivity and specificity were 73.20,96.20,82.10,81.20,respectively.The followed up was lasted for 30 days in 112 patients with PTIA,and there were 11 cases (9.82％) with secondary cerebral infarction within 7 days,17 cases (15.18％) within 8 to 30 days.The relative risk rate of IMA level at 3 h and miR-126 level at 12 h in secondary ischemic stroke after PTIA were Rr =8.45,9.84;CI:1.10 to 65.03,1.13 to 86.02;P =0.040,0.039.Conclusion The early detection of IMA and miR-126 levels is of great value in diagnosis of PTIA and in prediction of secondary cerebral infarction.

Objective To investigate the value of ischemic modified albumin (IMA) and microRNA-126 (miR-126) in diagnosis of posterior circulation transient ischemic attack (PTIA) and in prediction of secondary cerebral infarction.Methods The clinical materials of 112 patients with PTIA were retrospectively analyzed.Serum IMA and miR-126 levels were measured at 3,6 and 12 h,and the correlation between serum IMA,miR-126 levels and PTIA as well as secondary cerebral infarction was analyzed by ABCD2 score.Results Serum IMA level was (54.19 ± 10.10) U/L in 80 healthy controls,and were (85.81 ±20.21),(62.98 ±12.79),(57.66 ±13.39) U/L at 3,6 and 12 h,respectively,in 112 patients with PTIA.and its levels of miR-126 at 6,12 h after PTIA attack were significantly decreased compared with (9.35 ± 1.76) in the healthy controls(P =0.036,P =0.001).In the patients with PTIA,the level of IMA at 3 h was negatively correlated with the level of miR-126 at 12 h (r =-0.3 13,P =0.0 00).When IMA and miR-12 6 levels were 6 7.5 2 U / L and 8.64,the sensitivity and specificity were 73.20,96.20,82.10,81.20,respectively.The followed up was lasted for 30 days in 112 patients with PTIA,and there were 11 cases (9.82％) with secondary cerebral infarction within 7 days,17 cases (15.18％) within 8 to 30 days.The relative risk rate of IMA level at 3 h and miR-126 level at 12 h in secondary ischemic stroke after PTIA were Rr =8.45,9.84;CI:1.10 to 65.03,1.13 to 86.02;P =0.040,0.039.Conclusion The early detection of IMA and miR-126 levels is of great value in diagnosis of PTIA and in prediction of secondary cerebral infarction.

Objective:To compare the effects of levosimendan injection at single dose and multiple doses on the left ventricular function , biomarkers and neuroho-rmonal activity in the patients with acute exacerbation of advanced heart failure .Methods:Totally 39 patients with chronic heart failure at acute exacerbation were divided into two groups , single dose group and multiple doses group .All the patients were given loading dose of 6μg· kg-1 levosimendan at baseline , and then given 0.1μg· kg-1 · min-1 continuous 24h in-fusion pump.The above regimen was administered once again after one month and six months in the patients of multiple doses group . Left ventricular end systolic volume ( LVESV ) , left ventricular end diastolic volume ( LVEDV ) , left ventricular ejection fraction (LVEF), mitral annulus systolic velocity (SM), myocardial performance index (MOI), blood brain natriuretic peptide (NT-proB-NP), tumor necrosis factor alpha (TNF-α) and interleukin 6(IL-6) were compared between the two groups before the treatment , and after tge three-day and 6-month treatment.Results:Compared with those before the treatment , LVESF, LVEF, Sm, MPI, NT-proB-NP, IL-6 and TNF-αin in the two groups were significantly improved after the three-day treatment (P<0.05).The indices were sig-nificantly improved in multiple doses group after the 6-month treatment when compared with those before the treatment and in single dose group, and the differences were statistically significant (P<0.05).Conclusion: Repeated intravenous administration of levosi-mendan is superior to the single dose administration in improving hemodynamics and inflammatory factors .

Objective To predict a value of ischemia modified albumin (IMA) levels for assessing secondary cerebral infarction in patients with transient ischemic attack (TIA) in anterior circulation.Methods 105 patients with TIA in anterior circulation admitted to the hospital within 3 hours were retrospectively studied.Combined with ABCD2 score,the correlations of IMA levels at 3 h,6 h and 12 h with secondary cerebral infarction after anterior circulation TIA were analyzed.Results IMA level was 75.28 u/L within 3h after TIA,and the sensitivity and specificity of TIA in anterior circulation were 66.7％ and 76.2％ respectively.In the total of 105 patients,16 cases (15.2％) suffered from secondary cerebral infarction within 7d,and 21 cases (20.0％) within 8～30d.The serum IMA levels were (87.43±19.89)U/L,(63.88±12.51)U/L and (61.21±12.28)U/L at 3h,6h and 12h after TIA,respectively.A simple analysis showed that there was a linear correlation between the IMA level and ABCD2 scores (P=0.000,r=0.666).Kaplan-Meier survival curve analysis showed that the increased IMA level within 3h,and moderate to high ABCD2 score were the risk factors for secondary cerebral infarction after TIA in anterior circulation (P=0.012,0.041).Conclusions Early detection of IMA has a clinical value similar to ABCD2 score to predict secondary cerebral infarction in patients with TIA in anterior circulation.