By applying "homeostasis" to the study of the meridian and collateral system， the concept of meridian and collateral homeostasis has been proposed which refers to a balanced and stable state of meridian and collateral system， and plays an important role in maintaining body health and can provide a reference for the diagnosis and treatment of diseases. Phenomics realizes the cross-scale correlation from micro-phenotypic data， such as genome， proteome， and metabolome， to macro-phenotypic data， such as physiological state， behavioral activities， and external manifestations. From the perspective of phenomics， this paper proposes a meridian and collateral homeostasis dynamic mapping model of "macroscopic signs and microscopic expression". This model combines macro signs such as the four examinations of traditional Chinese medicine （TCM）， biophysical indicators of acupoints， and micro expression information such as genes， proteins， and metabolism， and systematically investigates the relationship between meridian and collateral homeostasis and health and disease， thereby providing ideas and references for the identification of pre-disease states as well as precise diagnosis and treatment in TCM.

Objective:To compare the efficacy of monopolar electric scissors and harmonic scalpel in Da Vinci robot-assisted distal pancreatectomy.Methods:A total of 31 patients undergoing Da Vinci robot-assisted distal pancreatectomy at the Affiliated Hospital of Xuzhou Medical University from July 2020 to December 2023 were included. There were 9 males and 22 females, aged (54.4±15.7) years. Thirty-one patients who underwent Da Vinci robot-assisted distal pancreatectomy by monopolar electric scissors were included in the monopolar electric scissors group ( n=12), with a multi-joint flexible rotating mechanical arm to complete the dissection and separation and the other were inducled in harmonic scalpel group ( n=19). Operation time, intraoperative blood loss, spleen preservation, postoperative exhaust time, postoperative hospital stay, postoperative complications and total hospitalization cost were compared between the two groups. Results:Postoperative pathology confirmed that among the 31 patients, there were 6 cases (19.4%) serous cystadenomas, 5 cases (16.1%) mucinous cystadenomas, 3 cases (9.7%) pancreatic neuroendocrine tumors, 6 cases (19.4%) solid pseudopapilloma, 5 cases (16.1%) pancreatic cysts, and 3 (9.7%) benign cystic lesions, 3 cases (9.7%) were not easily classified. All the operations were successfully completed without conversion to laparotomy or death. There were no significant differences in operation time, intraoperative blood loss, splenic preservation rate, postoperative hospital stay and total hospitalization cost between the two groups (all P>0.05). The exhaust time in the monopolar electric scissors group was (2.8±0.7) d, which was shorter than that in the harmonic scalpel group (3.6±0.7) d, and the difference was statistically significant ( t=-2.88, P=0.007). There was no postoperative bleeding in both groups. In the monopolar electric scissors group, there were 4 cases of postoperative complications, all of which were pancreatic fistula, including 2 cases of biochemical leakage and 2 cases of B-grade pancreatic fistula. In the harmonic scalpel group, 8 cases had postoperative complications, 7 cases of pancreatic fistula, including 3 cases of biochemical leakage, 4 cases of B-grade pancreatic fistula, and 3 cases of abdominal infection, which were cured after treatment. There was no significant difference in the incidence of postoperative complications between the two groups ( P=0.717). Conclusion:The application of monopolar electric scissors in Da Vinci robot-assisted distal pancreatectomy could be safe and feasible in experienced hands, which could also utilize the advantages of robot system.

Objective:To compare Da-vinci robotic surgical system with laparoscopic surgery for the repair of hiatal hernia.Methods:The clinical data of 115 patients undergoing minimally invasive Nissen fundoplication at the Department of Hernia and Abdominal Wall Surgery, the Affiliated Hospital,Xuzhou Medical University from Dec 2019 to May 2022 were retrospectively studied. After propensity score matching (PSM), 46 cases in each group were included:Robot-assisted surgery (RS group) and laparoscopic surgery (LS group). Postoperative complications were collected and GERD Questionnaire (GERDQ) were used as the standard in evaluation of the results.Results:Patients in RS group had less intraoperative bleeding ( P<0.001), shorter postoperative gastrointestinal recovery time ( P<0.001), and shorter postoperative hospital stay ( P=0.002). The LS group had a shorter operative time ( P<0.001) and lower total hospital cost ( P<0.001). GERD-Q scores decreased significantly in both groups at 3 and 6 months postoperatively compared with preoperative scores ( P<0.001). There was no statistically significant difference between the two groups in the incidence of postoperative complications ( P>0.05). No recurrence was seen in both groups during postoperative follow-up. Conclusion:Da-vinci robot-assisted repair of hiatal hernia is as safe and feasible as laparoscopic procedures, with less intraoperative trauma and quicker, earlier recovery.

Objective:To investigate the safety and efficacy of using bio-artificial dura mater to wrap around skeletonized hepatic artery during pancreatoduodenectomy in the prevention of gastroduodenal artery(GDA)stump related delayed bleeding.Methods:Clinical data were collected from 45 patients undergoing the bio-artificial dura mater wrapping skeletonized hepatic artery during pancreatoduodenectomy from Oct 2022 to Apr 2023 at Department of General Surgery, the Affiliated Hospital of Xuzhou Medical University.Results:Among the 45 patients, the bio-artificial dura mater was used to completely wrap the GDA stump and part of the common hepatic artery and the proper hepatic artery. The mean operative time was (308.1±93.1) min, the mean wrapping artery time was (18.7±7.5) min. Clinically relevant postoperative grade B pancreatic fistula (CR-POPF) occurred in 6 cases (13.3%), and intra-abdominal infection in 2 cases (4.4%).The rate of bile leakage was 2.2%.There were no second surgical operation, nor perioperative death. Postoperative delayed bleeding occurred in one case (2.2%) on the right hepatic artery branch near the hepatic portal. No pseudoaneurysm formation, nor bleeding occurring in any of the arteries wrapped by bio-artificial dura mater (including the GDA stump) after PD. There were no postoperative hepatic artery wrapping complications, such as hepatic artery stenosis, mesh-associated fluid accumulation and infection.Conclusion:Bio-artificial dura mater wrapping skeletonized hepatic artery technique in the process of pancreaticoduodenectomy can reduce the risk of delayed bleeding due to erosion of GDA stumps in case of post-PD pancreatic fistula.

Objective:To study the use of the da Vinci robot in distal pancreatectomy.Methods:The data of 53 patients who underwent minimally invasive distal pancreatectomy at the Department of General Surgery of the Affiliated Hospital of Xuzhou Medical University from February 2017 to March 2022 were retrospectively analysed. There were 16 males and 37 females, aged (48.2±16.9) years. These patients were divided into the robot assisted pancreatectomy group (the robot group, n=18) and the laparoscopic pancreatectomy group (the laparoscopic group, n=35) based on the surgical treatment methods. The operations were performed by the same team of surgeons. All patients were diagnosed to have benign or borderline malignant tumors of body and tail of pancreas by preoperative examinations. The success rate of spleen preservation distal pancreatectomy, operation time, intraoperative bleeding, and postoperative complications (including pancreatic fistula, postoperative bleeding, abdominal infection) were compared between the two groups. Results:Spleen preserving distal pancreatectomy was successfully carried out in 13 patients (72.2%) in the robot group and 15 patients (42.9%) in the laparoscopic group. The rate of spleen preservation in the robot group was significantly higher than that in the laparoscopic group (χ 2=4.11, P=0.043). Intraoperative blood loss (104.4±69.3) ml and time to first postoperative passage of flatus were (3.7±1.0) d in the robot group were significantly better than the laparoscopic group (199.4±102.9) ml and (4.8±1.3) d, respectively (both P<0.05). The total incidence of complications in the robot group was 7 cases (38.9%), compared with 14 cases (40.0%) in the laparoscopic group, with no significant difference between the two groups(χ 2=0.006, P=0.938). Conclusions:Robotic-assisted distal pancreatectomy was safe and feasible, and it had advantages in resulting in better spleen preservation than laparoscopic distal pancreatectomy.

Objective:To find out whether surgeon's proficiency in laparoscopic gastrectomy helps to get over the learning curve of laparoscopic pancreaticoduodenectomy (LPD) more quickly.Methods:From January 2015 to October 2016, the clinical and perioperative data of 41 consecutive patients who underwent LPD at the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. The learning curves were evaluated using the CUSUMOT method and RA-CUSUM method.Results:Of 41 patients, 25 were males and 16 were females, with age ranging from 25.0 to 83.0 (60.6±13.7) years. These patients all successfully underwent LPD, with operation time Mean±SD being (456.3±85.9) min. There were 4 patients (9.8%) who developed biochemical fistula and 4 patients (9.8%) grade B pancreatic fistula. There was no grade C pancreatic fistula after operation. There were 10 patients who developed postoperative complications ≥ Clavien-Dindo grade III (24.39%) and 1 died. The data of the CUSUMOT method showed the learning curve to be over after the 33rd patient and the data of the RA-CUSUM method showed the learning curve to be over after the 31st patient.Conclusions:Laparoscopic gastrectomy helped surgeons to master the key techniques in LPD faster, and to get over the learning curve more safely and quickly.

Objective This study was to evaluate the relative applicability of serum cystatin C(Cys C)-based formulas and serum creatinine-based formulas for renal glomerular filtration rate(GFR) of Chinese children with chronic kidney disease(CKD).Methods Six hundred and nine Chinese CKD patients of less than 18 years old were enrolled from January 2011 to October 2016 in Shengjing Hospital of China Medical University.The value for estimated GFR (eGFR) was derived from using the 11 formulas,and 99mTc-DTPA renal dynamic imaging was the golden standard of standard GFR(sGFR).SPSS 22.0 statistical software was used to compare the accuracy of each assessment formula and the correlation between GFR markers(Cys C, β2-MG) and sGFR.Results A total of 609 children were enrolled,including 332 patients in CKD stage 1 (211 males and 121 females),165 patients in CKD stage 2(99 males and 66 females),70 patients in CKD stage 3(43 males and 27 females),22 patients in CKD stage 4(13 males and 9 females),and 20 patients in CKD stage 5(16 males and 4 females).All of the formulas either overestimate or underestimate GFR in chil-dren with CKD. In contrast with other formulas,CKD-EPI formula and Filler formula performed better regardless of gender and age difference.Serum β2-MG and serum Cys C all showed a negative relationship with sGFR(respectively r= -0.478 and r= -0.585,P<0.01).Conclusion CKD-EPI formula and Filler formula provide the better approximation to sGFR than other formulas in Chinese children with CKD.Howev-er,we need to try our best to enroll more patients to develop a more accurate GFR estimation formula in Chinese children.

Background Macular edema is one of the serious complications of central retinal vein occlusion (CRVO),and the present therapies are laser coagulation and intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs.Conbercept is humanized-monoclonal VEGF antibody and used for the treatment of retinal vascular diseases.However,fewer studies were focused on its application in macular edema secondary to CRVO.Objective The aim of this study was to compare the effectiveness and safety of conbercept with triamcinolone acetonide(TA)by intravitreal injections for macular edema secondary to CRVO. Methods A non-randomized controlled study was carried out under the approval of the informed consent of patients.Sixty eyes of 60 patients with macular edema secondary to CRVO were included in Weifang Yidu Central Hospital from March 2012 to August 2013.The eyes were divided into the conbercept group and TA group with 30 for each group.Conbercept and TA of 0.05 ml were intravitreally injected in different groups,and the best corrected visual acuity(BCVA),central macular thickness(CMT)measured by OCT,intraocular pressure(IOP)and relavant complications were examined before injection and 1 week,1 month,3 months and 6 months after injection.The treatment outcomes were compared intergrouply and along with time. Results The BCVA was evidently better in 1 week,1 month,3 months and 6 months after injection than that before injection both in conbercept group and TA group(all at P＜0.01),and the BCVA of TA group was better than that of conbercept group 1 week after injection(P＜0.05).The CMT values of Conbercept were(572.00± 100.01),(325.12±91.55),(280.00±92.37),(258.65 ±88.65),(300.00±87.64)μm,and those of TA group were(570.00± 102.21),(345.12±89.31),(290.00±80.27),(309.65 ±84.13)and(303.00±90.59)μm,and CMT value after injection was significantly lower in 1 week,1 month,3 months and 6 months after injection than that before injection both in the conbercept group and the TA group(all at P＜0.05),and CMT value was evidently reduced in the conbercept group compared with the TA group 3 months after injection(P＜0.05).The IOP was(15.20±3.52),(21.20±3.80),(26.40±4.00),(23.60±3.73)and(21.50±3.27)mmHg in the TA group before injection and 1 week,1 month,3 months and 6 months after injection,showing significnatly elavation after injection(all at P＜0.05),and the IOP at different time points was higher in the TA group than that in the conbercept group(all at P＜0.05).However,there was no considerable change of IOP before and after injection in conbercept group(all at P＜0.05). Conelutions Both conbercept and TA are effective for macular edema secondary to CRVO by intravtreal injection.Compared with TA,conbercept is much safer because of less risk of IOP rising after intravtreal injection.

Discuss the pathogenesis and treatment strategy of idiopathic thrombocytopenic purpura from the view of insidious pathogenic factors.The invasion,remission and recurrence of ITP implicated the theory model of insidious pathogenic factors,and it applied new thread for syndrome differentiation and treatment.

A method for the quantitative monitoring of sulfadiazine (SD) residues in pork was established by molecular imprinted column coupling with high performance liquid chromatography (HPLC).The molecular imprinted column was selected as an extraction device.To obtain the optimum extraction efficiency,several parameters related to the molecular imprinted column,including column solvent,flow-rate,eluent of the sample matrix and eluent volume,were investigated.The sample solution was directly injected into the device for the extraction after simple extraction.Under the optimum conditions,the relative standard deviations (RSD) was ≤6.1％ and the recoveries for SD were higher than 75.6％.In comparison with the AL-SPE column,the MIP-SPE column had good reusability and extraction efficiency.This method was successfully applied to the determination snlfadiazine residues in pork.