[Safety and feasibility of laparoscopic double-flap technique in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction tumors larger than 5 cm].

Objective: To investigate the safety and feasibility of laparoscopic double-flap technique (Kamikawa) in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction (EGJ) leiomyoma and gastrointestinal stromal tumor (GIST) with the maximum diameter >5 cm. Methods: A descriptive case-series study was used to retrospectively analyze the data of patients with EGJ leiomyoma and GIST undergoing laparoscopic-assisted proximal gastrectomy and double-flap technique (Kamikawa) at the Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine from September 2017 to March 2019. All the tumors invaded the cardia dentate line, and the maximum diameter was >5 cm. After the exclusion of patients requiring emergency surgery and complicating with severe cardiopulmonary diseases, a total of 4 patients, including 3 males and 1 female with age of 29-49 years, were included in this study. After laparoscopic-assisted proximal gastrectomy, the residual stomach was pulled out of the abdominal cavity and marked with methylene blue at the proximal end 3~4 cm from the anterior wall of the residual stomach in the shape of "H". The gastric wall plasma muscular layer was cut along the "H" shape, and the space between the submucosa and the muscular layer was separated to both sides along the longitudinal incision line to make the seromuscular flap. The residual stomach was put back into the abdominal cavity. Under laparoscopy, 4 stitches were intermittently sutured at the upside of "H" shape and 4-5 cm from the posterior wall of the esophageal stump. The stump of the esophagus was cut open, and the submucosa and mucosa were cut under the "H" shape to enter the gastric cavity. The posterior wall of the esophageal stump was sutured continuously with the gastric stump mucosa and submucosa under laparoscopy. The anterior wall of the esophageal stump was sutured continuously with the whole layer of the residual stomach. The anterior wall of the stomach was sutured to cover the esophagus. The anterior gastric muscle flap was sutured and embedded in the esophagus to complete the reconstruction of digestive tract. The morbidity of intraoperative complications and postoperative reflux esophagitis and anastomosis-related complications were observed. Results: All the 4 patients completed the operation successfully, and there was no conversion to laparotomy. The median operative time was 239 (192-261) minutes, the median Kamikawa anastomosis time was 149 (102-163) minutes, and the median intraoperative blood loss was 35 (20-200) ml. The abdominal drainage tube and gastric tube were removed, and the fluid diet was resumed on the first day after surgery in all the 4 patients. The median postoperative hospitalization time was 6 (6-8) days. Postoperative pathology revealed 3 leiomyomas and 1 GIST. There were no postoperative complications such as anastomotic leakage or stenosis, and no reflux symptoms were observed. The median follow-up time was 22 (11-29) months after the operation, and no reflux esophagitis occurred in any of the 4 patients by gastroscopy. Conclusion: For >5 cm EGJ leiomyoma or GIST, double-flap technique (Kamikawa) used for digestive tract reconstruction after proximal gastrectomy is safe and feasible.

Safety and feasibility of laparoscopic double-flap technique in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction tumors larger than 5 cm / 中华胃肠外科杂志

Objective: To investigate the safety and feasibility of laparoscopic double-flap technique (Kamikawa) in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction (EGJ) leiomyoma and gastrointestinal stromal tumor (GIST) with the maximum diameter >5 cm. Methods: A descriptive case-series study was used to retrospectively analyze the data of patients with EGJ leiomyoma and GIST undergoing laparoscopic-assisted proximal gastrectomy and double-flap technique (Kamikawa) at the Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine from September 2017 to March 2019. All the tumors invaded the cardia dentate line, and the maximum diameter was >5 cm. After the exclusion of patients requiring emergency surgery and complicating with severe cardiopulmonary diseases, a total of 4 patients, including 3 males and 1 female with age of 29-49 years, were included in this study. After laparoscopic-assisted proximal gastrectomy, the residual stomach was pulled out of the abdominal cavity and marked with methylene blue at the proximal end 3~4 cm from the anterior wall of the residual stomach in the shape of "H". The gastric wall plasma muscular layer was cut along the "H" shape, and the space between the submucosa and the muscular layer was separated to both sides along the longitudinal incision line to make the seromuscular flap. The residual stomach was put back into the abdominal cavity. Under laparoscopy, 4 stitches were intermittently sutured at the upside of "H" shape and 4-5 cm from the posterior wall of the esophageal stump. The stump of the esophagus was cut open, and the submucosa and mucosa were cut under the "H" shape to enter the gastric cavity. The posterior wall of the esophageal stump was sutured continuously with the gastric stump mucosa and submucosa under laparoscopy. The anterior wall of the esophageal stump was sutured continuously with the whole layer of the residual stomach. The anterior wall of the stomach was sutured to cover the esophagus. The anterior gastric muscle flap was sutured and embedded in the esophagus to complete the reconstruction of digestive tract. The morbidity of intraoperative complications and postoperative reflux esophagitis and anastomosis-related complications were observed. Results: All the 4 patients completed the operation successfully, and there was no conversion to laparotomy. The median operative time was 239 (192-261) minutes, the median Kamikawa anastomosis time was 149 (102-163) minutes, and the median intraoperative blood loss was 35 (20-200) ml. The abdominal drainage tube and gastric tube were removed, and the fluid diet was resumed on the first day after surgery in all the 4 patients. The median postoperative hospitalization time was 6 (6-8) days. Postoperative pathology revealed 3 leiomyomas and 1 GIST. There were no postoperative complications such as anastomotic leakage or stenosis, and no reflux symptoms were observed. The median follow-up time was 22 (11-29) months after the operation, and no reflux esophagitis occurred in any of the 4 patients by gastroscopy. Conclusion: For >5 cm EGJ leiomyoma or GIST, double-flap technique (Kamikawa) used for digestive tract reconstruction after proximal gastrectomy is safe and feasible.

Effect of emotional freedom technique on perceived stress, anxiety and depression in cancer patients: a preliminary experiment / 现代临床护理

Objective To evaluate the effect of emotional freedom technique (EFT) on the levels of perceived stress, anxiety and depression in cancer patients. Methods Fifteen cancer patients received the intervention of EFT once per day for one week. The effect was evaluated with the Chinese version of perceived stress scale (CPSS), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) before and after the intervention. Result The total scores of SAS, CPSS and SDS after the intervention were significantly lower than those before the intervention (P<0.01). Conclusion EFT can effectively reduce the levels of perceived stress, anxiety and depression in cancer patients.

Temporal bone paraganglioma

OBJECTIVE: The aim of the study was to describe the diagnosissurgical management and outcomes of eight patients with bone paraganglioma.PATIENTS: A series of 8 patients with temporal bone paraganglioma were seen over a 10-year period and operated n by the senior author.RESULTS: The majority of patients presented with hearing loss and pulsatile tinnitus. Other symptoms were facial numbness, facial asymmetry, dizziness, hoarseness, and dysphagia. All patients had pre-operative high resolution computed temography (HRCT) scan and/or magnetic resonance imaging. Pre-operative angiography and embolization facilitated the excision of these tumors in all but one case. There was reversal of pre-existent cranial nerve neuropathy in 3 of 8 cases. Unique to this series were the management of a patient who previously underwent gamma knife radiosurgery, one case in whom the glomus tumor grew from the better hearing ear thus posing the surgical management challenges and a complicated case of postoperative necrosis that required latissimus dorsi flap reconstruction. Other complications were described including post-operative facial paresis which eventually resolved in all patients.CONCLUSION: In our setting, it is possible to achieve good result with acceptable morbidity with surgery with or without postoperative radiotherapy.

Clinical Research of Ulcerative Colitis Treated with Herbal Cake-partitioned Moxibustion / 针灸推拿医学（英文版）

Objective:To observe the effects of herbal cake.partitioned moxibustion and bran-partition moxibustion in improving symptoms of ulcerative colitis(UC)and the TNF-α and its receptor of colon mucosa.Method:67 UC cases were randomly allocated into herbal cake-partition moxibustion group of 35 cases and bran-partitioned moxibustion group of 32 cases,to compare the improvement and detect the TNF-α and its receptor with inlmunohistochemical method in both groups.Result:Herbal cake.partitioned moxibustion iS prior to bran-partitioned moxibustion in improving of diarrhea,flatus,lassitude,tenesmus and lumbar soreness;The expression of TNF-α,TNF-αR1,and TNF-αR2 are significantly decreased after treatment in herbal cake-partitioned moxibustion group,while in bran-partitioned moxibustion group only TNF-αR1 expression is significant decreased after treatment.Conclusion:Moxibustion can well improve the syndromes of UC.Herbal cake.partitioned Moxibustion is prior to bran-partitioned moxibustion in the improvement of diarrhea and flatus;Herbal cake-partitioned moxibustion could down-regulate the expression of TNF-α,TNF-αR1.and TNF-αR2.while bran-partitioned moxibustion could only down-regulate the expression of TNF-αR1.

Effect of recombinant human tumor necrosis factor receptor Ⅱ-Fc fusion protein on nuclear factor-κB protein expression and brain edema tranmalic brain injury in rats / 中国综合临床

Objective To investigate the effects of recombinant human tumor necrosis factor receptorⅡ-Fc fusion protein(rhTNFR:Fc ) on nuclear factor-κB(NF-κB)and tumor necrosis factor-α(TNF-α)protein expression in the rat brain tissue,and traumatic brain edema following acute traumatic brain injury(TBl).Methods The inju-ry rats were subjected to right lateral cortical impact injury caused by a free-falling object.In the rhTNFR:Fc group,rhTNFR:Fc was administered intraperitoneally(3.0 mg/kg)after 30 min of injury-and the rats of control and injury group administered with normal saline solution.The levels of TNF-α protein in rat brain were mensured by radio-im-munonssay(RIA).The NF-κB protein expression of rat brain was studied immunohistochemically.In the meantime,the water content of rat brain Was measured,and for the microscope and ultrastructure examinations by using electron-ic microscope respectively.Results Compared with control group,the levels of NF-κB and TNF-α protein and the water content of brain tissue were obvicously increased from 6 h following TBI(P<0.05,or P<0.01).Compared with injury group,the expression of NF-KB and TNF-α protein,and the brain water content were lower in rhTNFR:Fc group(P<0.05-P<0.01).The rhTNFR:Fc Can reduce the brain injury in electronic microscope examinations.Conclusion The expression of NF-κB and TNF-α,and the water content of rat brain increase significantly follow-ing acute traumatic brain injury.The rhTNFR:Fc can dramatically inhibit the expression of NF-κB and TNF-α,and alleviate rat brain edema after TBI.