Basic performance of domestic surgical robot and the safety and effectiveness of integrated energy equipment. / å›½äº§æ‰‹æœ¯æœºå™¨äººåŸºæœ¬æ€§èƒ½å’Œæ•´åˆèƒ½é‡è®¾å¤‡çš„å®‰å ¨æ€§åŠæœ‰æ•ˆæ€§.

OBJECTIVES: Surgical robot system has broken the limitation of traditional surgery and shown excellent performance in surgery, and has been widely used in minimally invasive treatment in most areas of surgery. This study aims to verify the basic performance of the domestic surgical robot system and the safety and effectiveness of the integrated bipolar electrocoagulation and ultrasonic knife. METHODS: The basic performance of the domestic surgical robot system was evaluated by completing the square knot and surgical knot, vertical and horizontal perforation and right ring perforation and suture, as well as picking up beans. Compared with laparoscopy, the safety and effectiveness of the domestic surgical robot after integrated interconnection bipolar electrocoagulation and ultrasonic scalpel were evaluated by detecting the vascular closure performance and the degree of histopathological damage in animals. RESULTS: Compared with freehand knotting, domestic robot knotting speed and circumference were slightly worse, but better than laparoscopic knotting. There was no statistical significance in the tension difference of the surgical knots among the 3 methods (P>0.05), but the tension of the square knots made by the freehand and the domestic surgical robot was greater than that of the laparoscopy (P<0.05). The space required for both the left and right forceps heads of knots was smaller than that of laparoscopy (P<0.001), which successfully completed the 4 quadrant suture tasks, and the time of picking up beans was significantly less than that of laparoscopy (P<0.05). There was no significant difference in the temperature of the liver tissue after the bipolar electrocoagulation between the interconnected domestic surgical robot and the laparoscopy (P>0.05), and the acute thermal injury was observed under the light microscope. The temperature of the liver tissue treated by the domestic robotic ultrasound knife was higher than that of the laparoscopic ultrasound knife (P<0.05). CONCLUSIONS: Domestic surgical robots are obviously superior to laparoscopy in suturing, knotting, and moving objects, and domestic surgical robots' interconnect bipolar electrocoagulation and ultrasonic knife have achieved success in animal experiments, and hemostasis is considered to be safe and effective.

Analysis of the Clinical Characteristics of Dipeptidyl Peptidase-4 Inhibitor-Induced Bullous Pemphigoid.

OBJECTIVE: To analyze and discuss the clinical characteristics of dipeptidyl peptidase-4 inhibitor (DPP4i)-induced bullous pemphigoid (BP). DATA SOURCES: We collected case reports of DPP4i-induced BP by searching databases from 2006 to mid-May 2021, as a retrospective analysis. STUDY SELECTION AND DATA EXTRACTION: Relevant case reports and case analyses of DPP4i-induced BP were included. DATA SYNTHESIS: The median time of symptom onset was 9 months (range 0.5-59 months). BP most often occurred in patients receiving vildagliptin (52.63%) followed by linagliptin (27.19%) and sitagliptin (17.54%). Tense bullae and blisters (85.51%) and erythema (82.61%) on the extremities and trunk were the most common presenting symptoms. In total, 64.06% of BP patients were anti-BP180 autoantibody positive, 58.97% were BP180NC16a autoantibody positive, and 31.25% were anti-BP230 autoantibody positive. Skin biopsy revealed subepidermal bulla eosinophil infiltration in 93.85% of BP patients, lymphocyte infiltration in 56.93%, and neutrophil infiltration in 44.62%. Direct immunofluorescence was positive in 98.94% of BP patients with linear deposition of IgG (97.80%) and/or complement C3 (98.94%) along the basement membrane zone. Indirect immunofluorescence was positive in 87.88% of BP patients. Complete remission of BP was achieved in 83.64% of patients on DPP4i withdrawal and after 4 months (range 0.13-72 months) of follow-up. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: This review analyzes and discusses the clinical characteristics of DPP4i-induced BP and provides a reference for the safe and reasonable clinical application of DPP4i. CONCLUSIONS: DPP4i drugs are related to the occurrence of BP in diabetic patients, especially elderly men taking vildagliptin.

Retrospective analysis of skin photosensitivity induced by pirfenidone.

WHAT IS KNOWN AND OBJECTIVE: Knowledge regarding the association between photosensitivity and pirfenidone is based mainly on case reports. The purpose of this article was to evaluate the clinical characteristics of photosensitivity associated with pirfenidone. METHODS: We collected studies on photosensitivity induced by pirfenidone published from 2008 to 31 August 2021 in Chinese and English for a retrospective analysis. RESULTS AND DISCUSSION: The median age was 70 years (range 57-80) in 22 patients with pirfenidone-induced photosensitivity. The dose at the onset of symptoms ranged from 600 to 2403 mg for the treatment of idiopathic pulmonary fibrosis. Pirfenidone-induced photosensitivity occurred within 1 week in some patients and up to 8 months in others. The most common clinical manifestation of photosensitivity caused by pirfenidone was itching on body parts exposed to sunlight (back of hands, face, neck, and limbs) in 15 patients followed by erythema in 13 patients. Histopathological examination revealed necrotic keratinocytes, lymphocytic inflammatory cell infiltrate, hyperkeratosis and liquefaction degeneration in 5 patients. The photosensitivity test showed a markedly decreased minimum erythema dose (MED) of 7-228 mJ/cm2 UV-B in 4 patients and 4.86-12 J/cm2 UV-A in 5 patients. The clinical symptoms were significantly improved or completely relieved with a median time of 4 weeks (range 1-8) after drug withdrawal, dose reduction or systemic and topical glucocorticoid therapy. WHAT IS NEW AND CONCLUSION: Clinicians should be aware of the potential phototoxic effects of pirfenidone and should inform patients to take pirfenidone during (or after) a meal, avoid sun exposure, wear protective clothing, and apply broad-spectrum sunscreen with high ultraviolet UVA and UVB protection.

Effect of laparoscopic Roux-en-Y gastric bypass on improvement of insulin resistance in Type 2 diabetic patients evaluated by hyperinsulinemic-euglycemic clamp. / é«˜èƒ°å²›ç´ -正葡萄糖钳夹实验评价Roux-en-Y胃旁路术对2åž‹ç³–å°¿ç— æ‚£è€ èƒ°å²›ç´ æŠµæŠ—çš„æ”¹å–„ä½œç”¨.

OBJECTIVES: With the increase of people's living standards increasing year by year, Type 2 diabetes has brought great economic and living burden to the society and patients. Bariatric surgery can improve metabolic indicators in patients with diabetes, but specific mechanisms are still under study. This study aims to evaluate the effect of Roux-en-Y gastric bypass (RYGB) on insulin resistance in patients with Type 2 diabetes by hyperinsulinemic-euglycemic clamp. METHODS: The peripheral glucose uptake (M value) of 40 patients undergoing laparoscopic Roux-en-Y gastric bypass surgery before and 6 months after the operation were analyzed hyperinsulinemic euglycemic clamp. Fasting blood glucose, glycosylated hemoglobin, triglycerides, andlow-density lipoprotein cholesterol levels as well as body mass index were also analyzed. RESULTS: M value of patients after laparoscopic Roux-en-Y gastric bypass was significantly higher than that before the operation, while indexes such as fasting blood glucose, glycosylated hemoglobin, triglycerides, and low-density lipoprotein cholesterol levels as well as body mass index were lower than those before the operation (all P<0.05). CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass surgery significantly improves insulin resistance in patients with Type 2 diabetes, decreases blood sugar and blood lipid, and can exert a positive effect on the treatment of Type 2 diabetes.

A Pilot Study of Nutritional Status Prior to Bariatric Surgery in South China.

Objective: The was a pilot study to assess the biochemical and historical information about bariatric patients before undergoing the surgery in the aim of identifying nutritional deficiencies and their prevalence from 2015 to 2020. Methods: Clinical data of 247 patients (105 males and 142 females) were included. Vitamins, trace elements, electrolytes, albumin, globulin, hemoglobin, folate, ferritin, microalbuminuria (MAU), and parathyroid hormone (PTH) levels were determined to explore the nutritional status according to gender, age, high body mass index (BMI), and waist circumstance (WC). Results: The mean age, mean BMI, and mean WC of the candidates were 32.95 ± 10.46 years, 38.01 ± 7.11 kg/m2, and 117.04 ± 16.18 cm, respectively. The prevalence of preoperative nutritional deficiencies was 76.88% for 25 (OH) vitamin D, 19.84% for globulin, 11.74% for albumin, 11.02% for sodium, 8.33% for folic acid, 10.48% (male) and 6.34% (female) for chloride, 4.05% for calcium, 3.07% (male) and 0.70%(female) for ferritin, 11.90% for elevated PTH, and 44.96% for MAU. Males exhibited increased prevalence of globulin and MAU relative to females (P < 0.05). Older groups are more likely to exhibit albumin deficiency (P = 0.007), globulin deficiency (P = 0.003), and zinc deficiency (P = 0.015). In addition, 25 (OH) D deficiency and albumin deficiency were more common in patients with BMI ≥ 47.5 kg/m2 (P = 0.049 and 0.015, respectively). Wider WC (≥150 cm) exhibited higher rates of albumin deficiencies (P = 0.011). Conclusion: Electrolyte and nutritional deficiencies were common in patients prior to bariatric surgery in South China. Routine evaluation of electrolyte and nutritional levels should be carried out in this population.

Effect of sleeve gastrectomy on gastroesophageal reflux in patients with metabolic syndrome. / è¢–çŠ¶èƒƒåˆ‡é™¤æœ¯å¯¹ä»£è°¢ç»¼åˆå¾æ‚£è€ èƒƒé£Ÿç®¡åæµç—‡çŠ¶çš„å½±å“.

OBJECTIVES: To investigate the incidence of gastroesophageal reflux disease (GERD) after sleeve gastrectomy and the effect of sleeve gastrectomy in treating the symptom of gastroesophageal reflux in patients with metabolic syndrome. METHODS: We retrospectively analyzed 60 patients with metabolic syndrome who received laparoscopy sleeve gastrectomy in the Department of Bariatric and Metabolic Surgery, Third Xiangya Hospital of Central South University from April 2018 to May 2019, and assessed the changes of symptoms before and after surgery. RESULTS: The study included 31 men and 29 women. The age of these patients was 16-46 (29.17±7.23) years, ranging from 16 to 46 years. The weight and body mass index (BMI) of the patients decreased from (116.02±31.96) kg and (39.67±8.90) kg/m2 to (98.32±25.22) kg and (34.4±7.85) kg/m2 at 1 month after the surgery, respectively. The number of patients with gastroesophageal reflux was 37(61.67%) before the surgery, and 18(30.00%) at 1 month after the surgery, respectively. The number of asymptomatic patients before the surgery while had gastroesophageal reflux symptoms within 1 month after the surgery was 4(6.67%). Among the 37 patients, 6(16.62%) had persisted or worsen symptoms with gastroesophageal reflux symptoms before the surgery, 23(62.16%) had no symptoms, and 8 patients (21.62%) showed improvement of gastroesophageal reflux 1 month after the surgery. Some scores of the GERD-Health-Related Quality of Life Scale (such as reflux after dinner) were significantly lower after the surgury than those before the surgery (P<0.05). CONCLUSIONS: The symptoms of GERD are effectively improved after surgery. Sleeve gastrectomy is a feasible, safe and effective treatment for obesity with GERD.

Retrospective analysis of the clinical characteristics of adefovir dipivoxil-induced Fanconi's syndrome in the Chinese population.

WHAT IS KNOWN AND OBJECTIVE: To explore the clinical characteristics of adefovir dipivoxil-induced Fanconi's syndrome in the Chinese population and provide a reference for rational drug use in the clinic. METHODS: By searching the CNKI, Wanfang, Chinese VIP, PubMed/MEDLINE, Web of Knowledge, Ovid, Elsevier and SpringerLink databases during 1 January 2008 to 31 December 2019, 78 studies of ADV-induced Fanconi's syndrome involving a total of 110 patients were collected and analysed retrospectively. RESULTS AND DISCUSSION: Prolonged usage of adefovir dipivoxil at low doses to treat hepatitis B might cause Fanconi's syndrome as the first symptom, especially for use over 12 months.The main clinical manifestation was bone pain accompanied by hypophosphataemia, elevated alkaline phosphatase (ALP), urine glycosuria and urine protein. X-rays and bone mineral density (BMD) examinations were mainly used to characterized osteoporosis. The patients had pain relief within 1 week to 1 month, and the biochemical indicators returned to normal within from 2 to 4 months. WHAT IS NEW AND CONCLUSION: Sufficient attention is required before and during exposure to long-term ADV therapy. The clinical picture, laboratory and radiograph alterations are important clues for ADV-induced Fanconi's syndrome.

Comparative study of surgical knots using a domestically produced Chinese surgical robot, laparoscope, or barehanded approach.

BACKGROUND: We conducted a comparative analysis of the first domestically produced Chinese surgical robot, 'MicroHand', laparoscopic, and barehanded approaches in tying surgical knots. METHODS: Four surgeons performed square or triple knots individually using the three approaches and documented the operational time, circumference, the bearable tension and action trajectory for each knot. RESULTS: MicroHand took more time than the barehanded method but nearly the same as with the laparoscope. The barehanded method generated the smallest knots among the three approaches and MicroHand produced smaller square knots than those by laparoscope. MicroHand and barehanded methods produced square knots displaying higher bearable tension than those produced by the laparoscope. For the action trajectory, MicroHand operated in a smaller space than that needed by the laparoscope. CONCLUSIONS: The square knots produced by MicroHand were tighter and more solid than those by laparoscope, although the triple knots generated by the two methods were similar. Also MicroHand required a smaller operational space than the laparoscope.

[Perioperative nursing for gastric perforation repair operation performed by the first domestic surgical robot].

We reported a case of gastric perforation repair operation performed by the first domestic surgical robot, named Miaoshou. The comprehensive and accurate nursing assessments and targeted psychological care were performed before the surgery. Close observation and care, effective prevention and treatment of complications, and nice guidance of diet were conducted after the surgery. All of these measures exerted positive effects on successful operation and early rehabilitation for patients.