Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

Colorectal cancer is one of the most common malignant tumors and has become a serious threat to people's lives and health.The clinics currently use the tumor-lymph node-metastasis(TNM)staging system as the main reference standard for risk stratification and prognostic prediction in colorectal cancer,but there are still large differences in prognosis between patients with the same pathologic stage.Therefore,there is an urgent need for more accurate prognostic prediction models.Computational pathology is a new field that utilizes computers and artificial intelligence(AI)to analyze histopathological images.AI enables comprehensive and quantitative analysis of histopathological images,which shows significant value and potential in prognostic prediction of colorectal cancer.This article reviews the application of computational pathology in prognostic prediction and therapeutic response evaluation of colorectal cancer,and summarizes the problems of this technique in the prognostic prediction process as well as the future development direction.

Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

Objective:To investigate the effect of chimeric flap pedicled with superficial branch of superficial iliac circumflex artery in repair of soft tissue defect of dorsal hand combined with metacarpal bone defect.Methods:From May 2015 to January 2022, 34 patients(28 males and 6 females) of soft tissue defects of dorsal hand with metacarpal bone defects were treated in the Department of Orthopedics of Yibin Third People's Hospital. The age of patients ranged from 22 to 51 years old, with an average age of 37 years old. The areas of soft tissue defects after debridement were 2.5 cm×5.0 cm-4.5 cm×9.0 cm, and the defects were all in dorsal hand and dorsal wrist. The lengths of metacarpal bone defect were 1.8-4.1 cm. All the patients had only single metacarpal bone defect, among which: 14 patients had defects in first metacarpal bone, 7 in second metacarpal bone, 4 in third metacarpal bone, 8 in fourth metacarpal bone and 1 in fifth metacarpal bone. All the patients were repaired by chimeric flap pedicled with superficial branch of superficial iliac circumflex artery. The size of flaps were 3.6 cm×5.4 cm-5.2 cm×9.5 cm. Anticoagulation, thermal preservation and plaster fixation were applied for 4-6 weeks after surgery. Postoperative follow-ups included regularly outpatient clinic visit, telephone or Wechat reviews. Follow-up items covered: the feeling and appearance of flaps in recipient sites, healing of the donor sites and recovery of hand functions.Results:All the 34 chimeric flaps survived. Regular follow-up lasted for 3 to 15(average, 10) months. All incisions in the donor sites of hip healed in stage I. TPD of the flaps was 5.1-7.3(mean, 6.4) mm. Appearance of flaps in the receiving area were satisfactory without swelling. Movement of wrists and metacarpophalangeal joints met the basic requirement of movement. The healing time of metacarpal defect was 2-3 months with an average of 2.8 months. Hand functions were evaluated at excellent in 6 patients and good in 28, according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Conclusion:The chimeric flap pedicled with superficial branch of superficial iliac circumflex artery is an ideal flap to repair the soft tissue defect in dorsal hand combined with metacarpal bone defect. It has advantages of less donor site damage, good blood supply of flap, simple surgical procedure, and one-stage repair of a combined soft tissue and metacarpal bone defects.

Objective:To investigate the clinical characteristics of two Han families with familial vitreous amyloidosis (FVA) and the gene mutation.Methods:A pedigree investigation was performed.Two Han Chinese families with FVA treated in Xiangya Hospital of Central South University from January 2015 to December 2018 were collected.General examination and ophthalmic examination were performed among 112 members of the two families.Peripheral blood samples were collected from 32 family members (15 patients in MZ001 pedigree, 7 patients in MZ002 pedigree, and 5 persons with normal clinical phenotype from each pedigree) for DNA extraction, polymerase chain reaction (PCR) amplification, transthyretin ( TTR) gene screening and sequencing.Vitreous biopsy following three-channel 23-gauge pars plana vitrectomy was performed on the two probands in the two families.Vitreous specimens were sent for pathological examination.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Xiangya Hospital of Central South University (No.201412463), and written informed consent was obtained from all subjects before any medical examination. Results:In MZ001, there were 15 cases of the 63 members presented bilateral vitreous opacity at an average age of (43.6±5.8) years.No lesion was found in nervous system, cardiovascular system, kidney or liver in general inspection.The vitreous of the proband (Ⅲ13) was so sticky that could not be totally removed during vitrectomy.The vitreous specimen showed positive Congo red staining.Ⅲ13 had elevated intraocular pressure after vitrectomy and was diagnosed as open-angle glaucoma.Gene sequencing revealed Gly83Arg mutation in the exon 3 of TTR gene.In MZ002, 7 cases of 49 members had bilateral vitreous opacity at an average age of (50.4±5.5) years, among which, 3 cases appeared symptoms of limb numbness and decreased muscle strength.The vitreous body of the proband (Ⅱ11) in MZ002 pedigree was looser and easier to remove during vitrectomy than that of Ⅲ13 in MZ001 pedigree.Vitreous specimen of Ⅱ11 was positive with Congo red staining.Gene sequencing revealed an Ala36Pro variant in the exon 3 of TTR gene. Conclusions:Gly83Arg or Ala36Pro mutation of TTR gene can cause FVA.Different mutations can lead to different clinical phenotypes such as age of onset, clinical symptoms and complications of other systems.

Objective:To compare the diagnostic accuracy of lung ultrasonography and radiography in detection of acute traumatic intrathoracic injuries in children.Methods:A retrospective analysis was performed in 46 cases of children with chest trauma in Shenzhen Children′s Hospital from January 2017 to January 2021. The diagnostic efficiency of lung ultrasound and radiography in children with acute traumatic hemopneumothorax and lung contusion were compared. Computed tomography scan was used as gold standard.Results:The sensitivity and specificity of lung ultrasound were 0.79 and 0.98 for pneumothorax, 0.86 and 0.75 for hemothorax, 0.86 and 0.80 for pulmonary contusion, respectively. Area under the ROC curve of ultrasonography in detection of pneumothorax, hemothorax, and pulmonary contusion was 0.889 (95% CI=0.798-0.979, P<0.001), 0.804 (95% CI=0.707-0.901, P<0.001), and 0.831 (95% CI=0.623-1.000, P=0.013), respectively. Area under the ROC curve of radiography was 0.674 (95% CI=0.544-0.803, P=0.008) for detection of pneumothorax, 0.645 (95% CI=0.517-0.772, P=0.026) for hemothorax, and 0.547 (95% CI=0.289-0.805, P=0.724) for pulmonary contusion. Comparison of area under the ROC curve declared the significant superiority of ultrasonography in detection of pneumothorax, hemothorax and pulmonary contusion (all P<0.05). Conclusions:Lung ultrasound has higher sensitivity and accuracy than chest radiography in the initial evaluation of chest trauma. For children with acute chest trauma, lung ultrasound should be the first choice.

Objective To evaluate the efficacy and safety of 27-gauge sutureless vitrectomy with air tamponade for rhegmatogenous retinal detachment (RRD).Methods The clinical data of 35 consecutive eyes with primary RRD from 35 patients who received 27-gauge vitrectomy with intraocular air tamponade in Zhongshan Eye Center from April 2016 to January 2017 were retrospectively analyzed.The mean follow-up duration was 8.6 months.Best corrected visual acuity (BCVA) (LogMAR) and intraocular pressure (IOP) were examined before surgery,1 week and 3 months after surgery.The operative duration,sclerotomy sites,retinal reattachment rate,intraoperative and postoperative complications were recorded.Results The mean duration of vitreous removal was (15.3 ± 3.6) minutes,and the mean duration of operation was (34.5 ± 4.8) minutes.No suturing process was performed at sclerotomy sites in all eyes.The retinal reattachment rate following a single procedure was 100％.The mean BCVA was significantly different among before surgery,1 week and 3 months after surgery (F =64.12,P＜0.01),and the BCVA at 1 week and 3 months after surgery was evidently improved in comparison with before surgery (0.82±0.31 vs.1.01 ±0.40;0.68±0.30 vs.1.01 ±0.40) (both at P＜0.05).The mean IOP was (14.69±3.66),(17.37±2.32) and (16.69±2.45) mmHg (1 mmHg =0.133 kPa) before surgery,1 week and 3 months after surgery,showing a significant difference among them (F=14.82,P＜0.01),and the IOP 1 week and 3 months after surgery was evidently higher than that before surgery (both at P＜0.05).The complications included intraoperative iatrogenic retinal breaks in 2 eyes,postoperative hypotony in 1 eye and hypertension in 5 eyes.These complications were curable.Conclusions 27-Gauge vitrectomy and air tamponade for RRD is an effective and safe approach.

Objective To investigate certified specialized nurses' willingness in building an reappraisal system and to provide a basis for further completing the appraisal system and criteria for specialized nurses, defining their roles, and encouraging them to play their leading roles in clinical work.Methods Totally 250 certified specialized nurses from 8 Class Ⅲ hospitals in Beijing were selected by convenient sampling and investigated with the self-designed questionnaire. The subjects' willingness in building the reappraisal system and criteria were analyzed.Results In terms of the 240 specialized nurses' wiliness in building the reappraisal system, their scores in clinical competence, teaching ability and research capability were (13.14±3.86), (13.60±2.27) and (9.50±2.94), respectively. There was statistical difference in the willingness in building the evaluation criteria of clinical competence between specialized nurses with different length of service and titles (P<0.05); there was also statistical difference in the willingness in building the evaluation criteria of teaching ability between specialized nurses with different educational background (P<0.05).Conclusions The specialized nurses' willingness in building the reappraisal indicators. Nursing managers shall train specialized nurses based on their shortcomings, build stricter criteria for future training for specialized nurses, and encourage the nursing team to become expert nurses.

Objective To investigate the diagnostic value of ultrasonography in radial head subluxation (RHS).Methods The clinical data and ultrasonographic findings of 34 children with RHS were retrospectively analyzed.All patients were routinely treated by bilateral compared and multi-sectional elbow joints ultrasonography.And the X ray results were negative.Results Ultrasonographic manifestations of RHS included increased radiocapitellar distance in 29 cases (29/34,85.29％);widened joint space and enhanced echo in 25 cases (25/34,73.53％);hook sign,supinator muscle above the radial head in 32 cases (32/34,94.12 ％);annular ligament entrapment in 33 cases (33/34,97.06％).Conclusion Ultra sonographic manifestations of RHS have certain characteristics.Comparation of bilateral elbow joints and the application of continuous scanning ultrasound are helpful to make a quick and accurate diagnosis of X-ray negative RHS.

Objective To investigate the effects of structured triglyceride and long chain triglyceride/medium chain triglyceride (LCT/MCT) on postoperative efficacies of elderly patients (≥70 years old) after total gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinical data of 42 elderly patients who underwent total gastrectomy for gastric cancer in the Jiangsu Cancer Hospital between Sepember 2014 and September 2015 were collected.Twenty-two patients using structured triglyceride in postoperative parenteral nutrition and 20 using LCT/MCT in postoperative parenteral nutrition were allocated into the case and control groups,respectively.All the patients underwent total gastrectomy + Roux-en-Y esophagojejunostomy.Patients in the case and control groups received respectively 20％ structured triglyceride and 20％ LCT/MCT.Observation indicators:(1) postoperative recovery situation:time of gut exsufflation,changes of body mass at postoperative 5 days,postoperative anastomotic leakage and abdominal infection;(2) test of liver function indexes:aspartate transaminase (AST),alanine transaminase (ALT),total bilirubin (TBil),direct bilirubin (DBil) of liver function in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5;(3) test of nutritional indexes:serum total protein (TP),albumin (Alb) and prealbumin in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5;(4) test of immunological indexes:levels of IgG and IgA,CD3,CD4 and ratios of CD3/CD8 in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5.Measurement data with normal distribution were represented as x ±s.Repeated measures data were evaluated with the repeated measures ANOVA.Count data were analyzed using the chi-square test and Fisher exact probability.Results (1) Postoperative recovery situation:there was no special adverse reaction during support treatment of parenteral nutrition.Time of gut exsufflation,changes of body mass at postoperative 5 days,incidences of postoperative anastomotic leakage and abdominal infection were (46 ± 12)hours,(60±8) kg,0,0 in the case group and (50 ±14) hours,(58±9)kg,0,1 in the control group,respectively,with no statistically significant difference between the 2 groups (t =0.86,0.65,P＞0.05).(2) Test of liver function indexes:levels of AST and ALT from preoperation to postoperative day 5 were respectively from (24±9) U/L to (22±6)U/L,from (31±12)U/L to (20±8)U/L in the case group and from (23±8) U/L to (30± 10) U/L,from (30 ± 9) U/L to (32 ± 7) U/L in the control group,respectively,with statistically significant differences between the 2 groups (F =92.87,87.92,P＜0.05).Levels of TBil and DBil from postoperative day 1 to postoperative day 5 were respectively from (21±4) μmol/L to (19±4) μmol/L,from (7.0±2.0) μmol/L to (6.0±2.0)μmol/L in the case group and from (19±3) μmol/L to (20±4)μmol/L,from (7.0±2.0)μmol/L to (8.0±3.0)μmol/L in the control group,respectively,with no statistically significant difference between the 2 groups (F =1.48,0.81,P ＞ 0.05).(3) Test of nutritional indexes:levels of serum TP and Alb from postoperative day 1 to postoperative day 5 were respectively from (52±6)g/L to (56±5)g/L,from (34±3)g/L to (37±4) g/L in the case group and from (53±7)g/L to (52±4)g/L,from (33±3) g/L to (31± 3)g/L in the control group,respectively,with no statistically significant difference in changing trends between the 2 groups (F=0.47,0.54,P ＞ 0.05).Levels of prealbumin from postoperative day 1 to postoperative day 5 were respectively from (230±32)mg/L to (245±30)mg/L in the case group and from (228±28)mg/L to (222±26) mg/L in the control group,respectively,with a statistically significant difference in changing trend between the 2 groups (F=16.81,P＜0.05).(4) Test of immunological indexes:levels of IgG and IgA,CD3,CD4 and ratios of CD4/CD8 from postoperative day 1 to postoperative day 5 were respectively from (12±4) g/L,(2.20±0.20)g/L,52％±4％,30％±4％,1.30±0.20 to (18±5)g/L,(2.80±0.30)g/L,59％±4％,33％±4％,1.50±0.20 in the case group and from (12±3)g/L,(2.10±0.10)g/L,52％±4％,27％±4％,1.30±0.10 to (13±4)g/L,(2.30±0.20) g/L,51％±4％,26％ ±4％,1.20±0.20 in the control group,respectively,with statistically significant differences in changing trends between the 2 groups (F=25.07,29.42,33.53,22.19,33.47,P＜0.05).Conclusions The short-term usage of structured triglyceride or LCT/MCT in early period after operation can effectively improve postoperative recovery of elderly patients with gastric cancer,with a small impact on liver function.Structured triglyceride can improve immunologic function and nutrition status more effectively.