High-strength antiswelling adhesive achieves both hemostasis and wound healing

Skin is one of the most vulnerable tissues,but there is a lack of injectable bioactive hydrogel dressings,which possess high strength,antiswelling capacity,and wet tissue adhesiveness,but also a rapid gelling process to enable rapid hemostasis,sutureless wound closure,and scarless healing of infected skin wounds[1e5].A new injectable,antibacterial,and multifunctional hydrogel dressings based on poly(citric acid-co-polyethylene glycol)-g-dopamine(PCPD)and amino-terminated Pluronic F127(APF)mi-celles loaded with astragaloside IV(AS)was developed for this pur-pose,as shown in Fig.1A[6].

Endoscopic hemostasis using self-expandable metal stent combinedwith PuraStat® for patient with high risk of post-endoscopicsphincterotomy bleeding (with video)

To the Editor:Endoscopic sphincterotomy(EST)is an established technique for removal of bile duct stones and self-expandable metal stent(SEMS)deployment.However,bleeding can be considered an adverse event after EST,particularly for patients with high risk of bleeding such as those on hemodialysis.Among the various techniques reported for obtaining endoscopic hemostasis[1-3].

Clinical Observation of the Hot and Humid Compress Therapy of Traditional Chinese Medicine in the Treatment of Qi Stagnation and Blood Stasis Type of Lumbar Disc Herniation

Background: Although a number of studies have reported that the hot and humid compress from traditional Chinese medicine (TCM) is effective in treating lumbar disc herniation (LDH) with qi stagnation and blood stasis, clinical evidence is limited. Objective: The purpose of this study is to provide high-quality evidence to support the effectiveness of the traditional Chinese hot and humid compress in the treatment of LDH with qi stagnation and blood stasis. Methods: From October 2021 to November 2023, 86 patients with LDH of qi stagnation and blood stasis type were recruited in our hospital and divided into a control (n = 43) and an observation group (n = 43) according to the random number table method. The control group was given routine clinical treatment, and the observation group was treated with the hot and humid compress therapy for two weeks. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, TCM syndrome score, serum interleukin-6 (IL-6), serum interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were observed and compared between the two groups before and after treatment, and the clinical efficacy of the two groups was evaluated. Results: After treatment, the VAS score, TCM symptom score, and serum IL-6, IL-1β, and TNF-α levels decreased in both groups (P P P P P Conclusions: The hot and humid compress of traditional Chinese medicine can effectively relieve pain, restore lumbar function, improve TCM syndromes, reduce the level of inflammatory factors, and have a curative effect in treating LDH.

Efficacy of activating blood and resolving stasis therapy for IgA nephropathy:a systematic review and meta-analysis

Background:To systematically evaluate the efficacy and safety of activating blood and resolving stasis in patients with IgA nephropathy.Methods:From inception to May 2022,databases including PubMed,Embase,the Cochrane Library,Web of Science,WanFang database,Chinese Biomedical Database,VIP,and China National Knowledge Infrastructure were searched for randomized controlled trials about enhancing blood circulation and removing stasis for IgA nephropathy.For the articles that satisfied the requirements,quality assessment and meta-analysis were done.Results:Seventeen randomized controlled trials with a total of 1653 patients were included.Meta-analysis showed that activating blood and resolving stasis could increase therapeutic effectiveness(risk ratio(RR)=-0.47,95%confidence interval(CI)(-0.37,-0.2),P=0.0006)and decrease levels of serum creatinine(RR=-0.47,95%CI(-0.37,-0.2),P=0.0006),urea nitrogen(RR=0.85,95%CI(1.44,0.26),P=0.005),24-hour urinary protein quantification(RR=1.6,95%CI(2.44,0.95).P=0.00001),and urine red blood cell count(RR=1.7,95%CI(2.57,0.82),P=0.0001).There was no significant difference between the two groups in terms of security(RR=0.6,95%CI(0.36,1.01),P=0.05).Conclusion:Western medicine combined activating blood and resolving stasis is more efficient than Western medicine therapy alone in treating IgA nephropathy,but it still needs to be supported by additional large-scale,multi-center randomized controlled clinical trials due to the poor quality of the included trials.

Correction: Efficacy of activating blood and resolving stasis therapy for IgA nephropathy: a systematic review and meta-analysis

Medical Data Mining published an article entitled Efficacy of activating blood and resolving stasis therapy for IgA nephropathy:a systematic review and meta-analysis on 16 January 2024.The author confirmed this article’s proof on 15 January 2024 without any questions.But on 15 April 2024,the authors contacted the editorial office to state that the name of the corresponding author is mis-spelled as“Han-Qing Zang”.Hence the mis-spelled name“Han-Qing Zang”is corrected as“Han-Qing Zhang”.“Han-Qing Zhang”is the third author of this article.

Exploring the medication pattern and mechanism of action of traditional Chinese medicine in treating polycystic ovary syndrome with kidney deficiency and blood stasis based on data mining and network pharmacology

Background:Using network pharmacology to explore the potential molecular mechanism of traditional Chinese medicine in treating polycystic ovary syndrome(PCOS)with kidney deficiency and blood stasis syndrome.Method:Collect the related literature materials of PCOS with kidney deficiency and blood stasis syndrome treated by traditional Chinese medicine in four databases in recent ten years,extract the information of prescriptions and complete the frequency analysis.Traditional Chinese Medicine Systems Pharmacology Database was used to screen out the effective components.Use Online Mendelian Inheritance in Man and other databases to screen PCOS disease targets.The intersection targets obtained by clustering prescription and PCOS disease targets were submitted to STRING database for protein-protein interaction network analysis,and Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes pathways were analysed by Metascape.Result:There are 155 kinds of traditional Chinese medicines used in the literature.The most commonly utilized ones are Cuscutae Semen,Angelicae Sinensis Radix,and Rehmanniae Radix Praeparata.The results of the cluster analysis indicated that the plants most commonly found throughout the prescription were Leonuri Herba,Lycopi Herba,Dipsaci Radix,etc.GO results show that biological processes include cell reaction to organic nitrogen compounds and cell reaction to nitrogen compounds.The functional display of GO molecule includes cytokine receptor binding,signal receptor regulator activity and so on.Kyoto Encyclopedia of Genes and Genomes results show that the possible mechanisms of action are cancer pathway,an endocrine resistance signal pathway.Conclusion:Through data mining,the cluster prescription for PCOS with kidney deficiency and blood stasis syndrome is Leonuri Herba,Lycopi Herba,Dipsaci Radix,etc.The network pharmacology research of cluster prescription shows that the main drug components for treating PCOS with kidney deficiency and blood stasis syndrome are quercetin,kaempferol,luteolin,tanshinone IIA,etc.,which act on PTGS2,NCOA2,and other targets,and treat PCOS with kidney deficiency and blood stasis syndrome through cancer and endocrine resistance.

Clinical Nursing Intervention of Moxibustion on Abdominal Distension Symptoms in Heart Failure (Heart and Kidney Yang Deficiency and Blood Stasis Blocking Collaterals Syndrome)

Objective:To investigate the clinical nursing intervention effect of moxibustion on abdominal distension symptoms in heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome).Methods:62 patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)admitted to our hospital from February 2023 to February 2024 were selected and divided into the observation group(n=31)and the control group(n=31)by using the random numerical table method.The control group adopted conventional nursing interventions,and the observation group received the nursing program of the control group with the addition of moxibustion nursing interventions.The nursing effectiveness,quality of life scores,and nursing satisfaction were compared between the two groups.Results:The nursing effectiveness of the observation group was significantly higher than the control group(P<0.05);the quality of life score of the observation group was significantly higher than the control group(P<0.05);the nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:The use of moxibustion nursing intervention in patients with heart failure(heart and kidney yang deficiency and blood stasis blocking collaterals syndrome)can effectively relieve the symptoms of abdominal distension,improve patients'quality of life,and increase nursing satisfaction,which has promotion and application values.

直线切割吻合器在儿童腹腔镜胆总管囊肿根治术Roux-en-Y吻合中的应用

目的探讨直线切割吻合器应用于儿童腹腔镜胆总管囊肿根治术Roux-en-Y吻合中的有效性、安全性及可行性。方法本研究为前瞻性研究,选取2020年1月至2023年1月湖南省儿童医院接受腹腔镜胆总管囊肿根治术Roux-en-Y吻合的34例患儿作为研究对象,按照随机数字表法进行分组,采用直线切割吻合器实施Roux-en-Y吻合术的患儿纳入观察组(n=17),采用传统缝合法实施Roux-en-Y吻合术的患儿纳入对照组(n=17)。记录两组患儿手术时长、术中出血量、术后肠道功能恢复时间、首次进食流质时间、拔除引流管时间、术后住院时间、总住院费用和术后并发症发生率。结果34例均顺利完成手术,无一例中转开放手术。观察组与对照组手术时长[(130.43±31.32)min比(141.51±30.39)min]、术中出血量[(55.45±20.73)mL比(58.62±22.13)mL]差异均无统计学意义(P>0.05);观察组与对照组患儿术后肠道功能恢复时间[(4.03±0.42)min比(4.91±1.13)min]、首次进食流质时间[(3.95±0.61)d比(4.88±1.09)d]、拔除引流管时间[(5.95±0.68)d比(6.65±1.28)d]、术后住院时间[(8.29±2.17)d比(10.33±2.18)d]均短于对照组,差异均有统计学意义(P<0.05);观察组与对照组患儿总住院费用[(34948.17±1019.57)元比(35151.91±1151.15)元]、并发症发生率(1/17比2/17)差异无统计学意义(P>0.05)。结论直线切割吻合器在儿童腹腔镜胆总管囊肿根治术Roux-en-Y吻合中与传统缝合吻合技术的有效性和安全性无明显差异,可促进患儿术后恢复,值得临床推广应用。

腹腔镜Roux-en-Y胃旁路术后内疝肠梗阻的防治

随着腹腔镜Roux-en-Y胃旁路术的开展,手术例数逐渐增加,其并发症的防治至关重要。肠梗阻是腹腔镜Roux-en-Y胃旁路术的严重并发症之一,临床症状不典型,诊断假阴性率较高,容易发展为肠坏死,造成严重后果。因此预防、诊断、治疗腹腔镜Roux-en-Y胃旁路术后肠梗阻是减少围手术期死亡、肠坏死等严重并发症的关键。内疝是肠梗阻最常见的病因,预防、早期诊断、治疗内疝可预防大部分肠梗阻的发生。本文现总结国内外减重代谢外科医师的工作经验,对腹腔镜Roux-en-Y胃旁路术后内疝肠梗阻的发病情况、影响因素、诊断要点、治疗方法及预防措施作一综述。

肝胆管盆式Roux-en-Y吻合术治疗复杂肝内胆管结石一例

左右叶肝内同时存在多发肝内胆管充满型成堆结石,或全肝5个或以上肝段内存在多发肝内胆管充满型成堆结石,而且不能通过肝段和(或)肝叶切除来除净的肝内胆管结石即称为复杂肝内胆管结石^([1-2])。目前临床上对复杂肝内胆管结石的治疗以肝切除术为主,少数甚至需要行肝移植术。有症状的肝内胆管结石既是患者的痛苦历程,亦往往是对外科医生的严峻挑战。70年代黄志强教授提出“解除梗阻、祛除病灶、取尽结石、通畅引流”的十六字原则。复杂肝内胆管结石治疗中采用盆式胆肠吻合术是指将已切开的1~3级肝管拼合、整形。

Heterogeneity of Outcomes Reporting in Trials Evaluating Traditional Chinese Medicine Breast Massage for Stasis Acute Mastitis: A Methodological Review

Objective To systematically analyze the current status of outcomes reporting in clinical trials on treating stasis acute mastitis with Traditional Chinese Medicine breast massage.Methods We searched CNKI,Wanfang,VIP,Sino Med,Pub Med,Web of Science,Embase,Cochrane library,JBI,CINAHL,Psyc INFO,Clinical Trials Registry Platform portal,Clinical Trials Registry,Australian New Zealand Clinical Trials Registry,Center Watch Registry from inception to May 15,2022 to find randomized controlled trials,non-randomized controlled trials,case series and cohort studies which reported the outcomes of stasis acute mastitis managed with Traditional Chinese Medicine breast massage,with search terms of mastitis,acute mastitis,lactation mastitis,puerperal mastitis,breast problem,breast engorgement,milk stasis,blocked ducked,breast pain,breast massage,and acupoint massage.Outcomes and the measurement schemes(measurement methods,timing of assessing outcome,frequency of assessing outcome,measurers)were extracted from the included studies.We used the Management of Otitis Media with Effusion in Children with Cleft Palate(MOMENT)to assess the quality of each study,then categorized outcomes derived from the included studies into different domains according to the Outcome Measures in Rheumatology Arthritis Clinic Trials(OMERACT)Filter 2.1 framework.Results We identified 85 clinical trials,in which 54 different outcomes were reported.A total of 81.2%(69/85)of studies were assessed as medium quality with a mean score of 2.6,and 18.8%(16/85)as low quality with a mean score of 0.9.These outcomes were organized in three core areas.Lump size(89.4%,76/85)was the most frequently reported outcome,followed by breast pain(69.4%,59/85)and milk excretion(68.2%,58/85).Five methods were used to assess lump size and four methods to assess breast pain.Conclusions The outcomes reported in clinical trials regarding stasis acute mastitis treated by Traditional Chinese Medicine breast massage are heterogeneous.Developing a core outcome set to achieve consistent standards for reporting outcomes and modalities for validation of the outcomes is clearly warranted.

Translation stalling and ribosome collision leading to proteostasis failure:implications for neurodegenerative diseases

Proteostasis denotes a cellular state in which protein synthesis,folding,and degradation are maintained at a homeostatic state such that an intact yet dynamic proteome is preserved.Cellular capacity to preserve proteostasis declines with age,which is assumed to contribute to the pathogenesis of age-related diseases.Proteostasis failure manifested as the formation of aberrant protein aggregates,including the amyloid plaques in Alzheimer’s disease(AD),Lewy bodies in Parkinson’s disease,and TAR DNA binging protein 43 inclusions in amyotrophic lateral sclerosis(ALS),is a defining feature of neurodegenerative diseases.

腹腔镜袖状胃切除术与Roux-en-Y胃旁路术的临床应用现状

肥胖已成为全球最严重的公共卫生问题之一,其进展性、复发性、异质性、多因素性、易引发多种相关疾病等特点,使肥胖的治疗面临严峻挑战。减重手术被认为是目前治疗肥胖及其相关代谢性疾病最有效的方法。近年迅速发展的减重代谢外科带来多样的手术方式,其中腹腔镜袖状胃切除术与腹腔镜Roux-en-Y胃旁路术一直备受关注,是目前的主流术式,临床应用最广。本文现对两种术式的临床应用现状作一综述。

Research Progress and Prospects on the Anti-liver Fibrosis,Blood Circulation-promoting and Stasis-resolving Effects of Curcuma kwangsiensis Based on W-P Bodies

Liver fibrosis is a necessary stage in the progression of chronic liver disease to cirrhosis.So far,no satisfactory drugs have been found to intervene in liver fibrosis.Liver microcirculation disorders are one of the important pathogenesis of chronic liver disease,and hepatic sinusoidal endothelial cells(HSECs)are the main cells that constitute the liver microcirculation barrier.In clinical practice,W-P bodies have been detected in HSECs of most patients with liver fibrosis.W-P bodies serve as a site for the synthesis and storage of vW factors,ET-1 and other cytokines that promote liver fibrosis.They can disrupt the structure and function of HSECs,cause liver microcirculation disorders,and exacerbate the progression of liver fibrosis.Previous studies have found that the Guangxi specialty ethnic medicine,C.kwangsiensis S.G.Lee et C.F.Liang,has definite effects in promoting blood circulation,resolving blood stasis,and resisting liver fibrosis.Based on this,a further research idea has been derived,stating that the blood circulation-promoting,blood stasis-resolving,and anti-liver fibrosis effects of C.kwangsiensis are produced by affecting the formation of W-P bodies,the synthesis and storage of contents in W-P bodies,and intervening in their exocytosis capacity.

Protocol to study the effects of AMPK-mTOR/PINK-Parkin dual signaling pathways on the formation of coronary heart disease showing blood stasis symptom pattern based on traditional Chinese medicine theory of“heart governing blood and vessels”

In this study,we aim to combine gene transfection techniques with the modeling methods previously employed by the research group to deeply investigate the corresponding theories of traditional Chinese medicine regarding“myocardial energy metabolism”and“aortic thrombosis”.Our goal is to elucidate the biological mechanism underlying the occurrence and development of coronary heart disease with blood stasis syndrome from the perspectives of“heart and vessels”and“Qi(in traditional Chinese medicine,it refers to the most fundamental and subtle substances that constitute the human body and maintain life activities.At the same time,it also has the meaning of physiological function.In terms of traditional Chinese medicine,Qi and different words are used together to express different meanings)and blood”.The research content is divided into four modules as follows:1.establishment of an animal model of coronary heart disease with blood stasis syndrome through fibrinogen overexpression.2.Investigation of the mitochondrial quality control system in coronary heart disease with blood stasis syndrome under fibrinogen overexpression.3.Study of platelet autophagy in coronary heart disease with blood stasis syndrome under fibrinogen overexpression.4.Examination of the relationship between the AMPK-mTOR pathway and metabolism in platelet autophagy of coronary heart disease with blood stasis syndrome under fibrinogen overexpression.Ninety-six Sprague Dawley rats will be randomly assigned to the following groups:control group,model group,fibrinogen group and adeno-associated virus group.All rats will undergo a 14-week model construction process,and modern molecular biology methods will be employed to evaluate the model and examine relevant research indicators.The obtained data will be analyzed according to a predefined statistical analysis plan.

Comparing the mechanism of four classic Gualou-Xiebai prescriptions for cardiovascular diseases with phlegm and blood stasis syndrome based on molecular network modeling

Background:Four classical Traditional Chinese Medicine prescriptions,namely Gualou Xiebai Baijiu decoction,Gualou Xiebai Banxia decoction(GLXBBX),Zhishi Xiebai Guizhi decoction(ZSXBGZ)and Danlou prescription(DL),have been frequently used for treatment of phlegm and blood stasis syndrome(PBSS)-related cardiovascular diseases.However,its therapeutic mechanism has not been clearly elucidated.This study aimed to explore PBSS and its molecular mechanism,clarify and compare the mechanisms of four prescriptions in treating PBSS-related diseases.Method:In this study,we collected four prescriptions’compounds,predicted therapeutic targets,and enriched pathways which were based on network pharmacology.Then,we analysed the commen and different mechanisms by combing the network of components,targets and pathways.Finally,molecular docking was engaged to assess the binding potential of key compounds and hub targets.Results:We showed that four prescriptions’intersection genes(VEGFA,SRC,EGFR,etc.)were commonly enriched in PI3K-AKT signaling pathway,HIF-1 signaling pathway,etc.In addition,platelet activation and cAMP signaling pathway were singly enriched from the GLXBBX through unique compounds 12,13-epoxy-9-hydroxynonadeca-7,10-dienoic acid and Cyclo(L-tyrosyl-L-phenylalanyl).These bioactive compounds may exert GLXBBX’s unique pharmacological pathways via involving in mediating PPARA,PTGER3,etc.Sphingolipid signaling pathway was singly enriched from the ZSXBGZ through unique compounds tetramethoxyluteolin,ergosterol peroxide,etc.These bioactive compounds could mediate ADORA1,ADORA3 and TNFRSF1A to regulate ZSXBGZ’s unique pharmacological pathways.AMPK signaling pathway was singly enriched from the DL through unique compounds kaempferol,evofolinb,ethyl acid and aureusidin.These bioactive compounds were involved in mediating the main targets of AMPK signaling pathway,such as TNF,TNFRSF1A,etc.Conclusions:Our research demonstrated that GLXB-prescriptions involved in almost all pathological stages of PBSS-related cardiovascular diseases by modulating high-frequency shared pathways and targets mainly through key compounds(quercetin,mandenol,sitosteryl acetate and luteolin,etc.),for example,participate in the process of atherosclerosis,lipid metabolism,inflammation,immune response,thrombosis,inhibit inflammatory factors and platelet aggregation,regulate immune function,vascular function,oxidative stress.In addition to common pharmacological efficacies,there could also be specificities among GLXB prescriptions due to different compounds.For example,GLXBBX tends to regulate the function of vascular and endothelial barrier,prevent thrombosis.ZSXBGZ tends to regulate lipid metabolism and protect the heart from lipid accumulation.DL tends to maintain energy homeostasis and improve inflammation.

Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

BACKGROUND Roux-en-Y gastric bypass(RYGB)is a widely recognized bariatric procedure that is particularly beneficial for patients with class III obesity.It aids in significant weight loss and improves obesity-related medical conditions.Despite its effectiveness,postoperative care still has challenges.Clinical evidence shows that venous thromboembolism(VTE)is a leading cause of 30-d morbidity and mortality after RYGB.Therefore,a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB candidates.AIM To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing RYGB.METHODS Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program,data from 6526 patients(body mass index≥40 kg/m^(2))who underwent RYGB were analyzed.A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of RYGB.The resultant risk scores were derived from the coefficients of statistically significant variables.The performance of the model was evaluated using receiver operating curves through 5-fold cross-validation.RESULTS Of the 26 initial variables,six predictors were identified.These included a history of chronic obstructive pulmonary disease with a regression coefficient(Coef)of 2.54(P<0.001),length of stay(Coef 0.08,P<0.001),prior deep venous thrombosis(Coef 1.61,P<0.001),hemoglobin A1c>7%(Coef 1.19,P<0.001),venous stasis history(Coef 1.43,P<0.001),and preoperative anticoagulation use(Coef 1.24,P<0.001).These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk post-RYGB.The risk model's area under the curve(AUC)was 0.79[95%confidence interval(CI):0.63-0.81],showing good discriminatory power,achieving a sensitivity of 0.60 and a specificity of 0.91.Without training,the same model performed satisfactorily in patients with laparoscopic sleeve gastrectomy with an AUC of 0.63(95%CI:0.62-0.64)and endoscopic sleeve gastroplasty with an AUC of 0.76(95%CI:0.75-0.78).CONCLUSION This simple risk model uses only six variables to assist clinicians in the preoperative risk stratification of RYGB patients,offering insights into factors that heighten the risk of VTE events.

Uncut Roux-en-Y吻合法在胆肠吻合术中的应用

目的评价Uncut Roux-en-Y吻合法在胆肠吻合术中的应用效果。方法选取2014年1月至2022年12月在我院接受胆肠吻合手术的55例患者。将40例采用传统Roux-en-Y胆肠吻合手术患者设为对照组,将15位接受Uncut Roux-en-Y胆肠吻合手术患者设为观察组。对比两组手术失血量、手术所需时间、术后恢复情况和并发症等。结果观察组在手术失血量、手术所需时间、术后排气时间、术后开始饮食的时间、术后胆红素下降程度、住院天数和住院总费用等方面均优于对照组(P<0.05)。两组术后并发症比较,无显著差异(P>0.05)。结论Uncut Roux-en-Y胆肠吻合术相较于传统Roux-en-Y胆肠吻合术更为安全、更经济,能够提高术后康复效果,值得推广应用。

Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.

非离断Roux-en-Y吻合用于腹腔镜远端胃癌根治术对患者术后康复效果的影响

目的 研究非离断Roux-en-Y吻合用于腹腔镜远端胃癌根治术对患者康复效果的影响,为临床提供参考。方法 回顾性分析2018年6月至2023年5月宜城市中医医院收治的60例行腹腔镜远端胃癌根治术患者的临床资料,根据吻合方式不同分为观察组(26例,给予非离断Roux-en-Y吻合)和对照组(34例,给予毕Ⅱ+Braun吻合)。比较两组患者手术相关指标、术后并发症发生情况、营养指标[白蛋白(ALB)和血红蛋白(Hb)]水平及生活质量。结果 两组患者手术时间、术中出血量、术后引流时间及术后住院时间比较,差异均无统计学意义(均P>0.05);观察组患者术后排气时间短于对照组(P<0.05)。两组患者并发症总发生率比较,差异无统计学意义(P>0.05)。观察组患者术后3个月的血清ALB和Hb水平均高于对照组(均P<0.05)。术后1、3个月,观察组患者胃癌患者生活质量问卷(QLQ-STO22)评分低于对照组(P<0.05)。结论 非离断Roux-en-Y吻合辅助腹腔镜远端胃癌根治术能有效改善患者术后营养状况和生活质量,促进患者尽早康复。