Short- and long-term outcomes of Roux-en-Y and Billroth II with Braun reconstruction in total laparoscopic distal gastrectomy: a retrospective analysis.

BACKGROUND: The controversy surrounding Roux-en-Y (R-Y) and Billroth II with Braun (BII + B) reconstruction as an anti-bile reflux procedure after distal gastrectomy has persisted. Recent studies have demonstrated their efficacy, but the long-term outcomes and postoperative quality of life (QoL) among patients have yet to be evaluated. Therefore, we compared the short-term and long-term outcomes of the two procedures as well as QoL. METHODS: The clinical data of 151 patients who underwent total laparoscopic distal gastrectomy (TLDG) at the Gastrointestinal Surgery Department of the Second Hospital of Fujian Medical University from January 2016 to December 2019 were retrospectively analyzed. Of these, 57 cases with Roux-en-Y procedure (R-Y group) and 94 cases with Billroth II with Braun procedure were included (BII + B group). Operative and postoperative conditions, early and late complications, endoscopic outcomes at year 1 and year 3 after surgery, nutritional indicators, and quality of life scores at year 3 postoperatively were compared between the two groups. RESULTS: The R-Y group recorded a significantly longer operative time (194.65 ± 21.52 vs. 183.88 ± 18.02 min) and anastomotic time (36.96 ± 2.43 vs. 27.97 ± 3.74 min) compared to the BII + B group (p < 0.05). However, no other significant differences were observed in terms of perioperative variables, including blood loss (p > 0.05). Both groups showed comparable rates of early and late complications. Endoscopic findings indicated similar food residuals at years 1 and 3 post-surgery for both groups. The R-Y group had a lower occurrence of residual gastritis and bile reflux at year 1 and year 3 after surgery, with a statistically significant difference (p < 0.001). Reflux esophagitis was not significantly different between the R-Y and BII + B groups in year 1 after surgery (p = 0.820), but the R-Y group had a lower incidence than the BII + B group in year 3 after surgery (p = 0.023). Nutritional outcomes at 3 years after surgery did not differ significantly between the two groups (p > 0.05). Quality of life scores measured by the QLQ-C30 scale were not significantly different between the two groups. However, on the QLQ-STO22 scale, the reflux score was significantly lower in the R-Y group than in the BII + B group (0 [0, 0] vs. 5.56 [0, 11.11]) (p = 0.003). The rest of the scores were not significantly different (p > 0.05). CONCLUSION: Both R-Y and B II + B reconstructions are equally safe and efficient for TLDG. Nevertheless, the R-Y reconstruction reduces the incidence of residual gastritis, bile reflux, and reflux esophagitis, as well as postoperative reflux symptoms, and provides a better quality of life for patients. R-Y reconstruction is superior to BII + B reconstruction for TLDG.

[Evaluation on clinical effectiveness of modified laparoscopic sacral colpopexy].

OBJECTIVE: To study clinical curative effect and complications of modified laparoscopic sacral colpopexy and evaluate the efficacy and safety of this procedure in treatment of pelvic organ prolapse (POP) . METHODS: From Jan. 2008 to Sept. 2012, 66 patients who had undergone modified laparoscopic sacral colpopexy for POP in the first affiliated hospital of Guangzhou medical university were studied retrospectively. Primary outcomes were assessed with POP quantitation ( POP-Q) system that was measured before or after operation respectively to evaluate the objective cure rate and recurrence rate.Secondary outcomes were measured by the pelvic floor distress inventory short form (PFDI-20) to evaluate the subjective cure rate, as well as to evaluate the improvement of postoperative lower urinary tract symptoms. RESULTS: Sixty-three patients were followed up for 6 to 57 months, and the median follow-up time was 16 months, the overall objective cure rate was 95% (60/63). Postoperative each indicator point was reset anatomically according to POP-Q, the overall objective cure rate was 90% (57/63), and the total recurrence rate was 10% (6/63). The median postoperative vaginal length was slightly shortened than preoperative length[7.5 cm versus 8.0 cm, P < 0.01]; the median score of postoperative PFDI-20 was obviously improved compared to the preoperative (21 versus 75 scores, P < 0.05); there was no statistically significant difference in POP-Q staging and questionnaire score at more than 3 years, >2- ≤ 3 years, >1- ≤ 2 years, <0.5-1 year after operation (P > 0.05). Among 23 patients with stress urinary incontinence (SUI) and 5 patients with mixed urinary incontinence (MUI), 15 cases underwent transvaginal tension free vaginal tape-obturator (TVT-O) procedure simultaneously, 13 cases did not. The cure rate of SUI was 14/15 and 10/13, respectively. CONCLUSIONS: Modified laparoscopic sacral colpopexy can not only reach the anatomical replacement stage but significantly improve the postoperative quality of life with high subjective and objective cure rate and few complications. The long-term curative effect is stable.

Tin/polypyrrole composite anode using sodium carboxymethyl cellulose binder for lithium-ion batteries.

A tin nanoparticle/polypyrrole (nano-Sn/PPy) composite was prepared by chemically reducing and coating Sn nanoparticles onto the PPy surface. The composite shows a much higher surface area than the pure nano-Sn reference sample, due to the porous higher surface area of PPy and the much smaller size of Sn in the nano-Sn/PPy composite than in the pure tin nanoparticle sample. Poly(vinylidene fluoride) (PVDF) and sodium carboxymethyl cellulose (CMC) were also used as binders, and the electrochemical performance was investigated. The electrochemical results show that both the capacity retention and the rate capability are in the same order of nano-Sn/PPy-CMC > nano-Sn/PPy-PVDF > nano-Sn-CMC > nano-Sn-PVDF. Scanning electronic microscopy (SEM) and electrochemical impedance spectroscopy (EIS) results show that CMC can prevent the formation of cracks in electrodes caused by the big volume changes during the charge-discharge process, and the PPy in the composite can provide a conducting matrix and alleviate the agglomeration of Sn nanoparticles. The present results indicate that the nano-Sn/PPy composite could be suitable for the next generation of anode materials with relatively good capacity retention and rate capability.

Graphene-encapsulated Fe3O4 nanoparticles with 3D laminated structure as superior anode in lithium ion batteries.

Fe(3)O(4)-graphene composites with three-dimensional laminated structures have been synthesised by a simple in situ hydrothermal method. From field-emission and transmission electron microscopy results, the Fe(3)O(4) nanoparticles, around 3-15 nm in size, are highly encapsulated in a graphene nanosheet matrix. The reversible Li-cycling properties of Fe(3)O(4)-graphene have been evaluated by galvanostatic discharge-charge cycling, cyclic voltammetry and impedance spectroscopy. Results show that the Fe(3)O(4)-graphene nanocomposite with a graphene content of 38.0 wt % exhibits a stable capacity of about 650 mAh g(-1) with no noticeable fading for up to 100 cycles in the voltage range of 0.0-3.0 V. The superior performance of Fe(3)O(4)-graphene is clearly established by comparison of the results with those from bare Fe(3)O(4). The graphene nanosheets in the composite materials could act not only as lithium storage active materials, but also as an electronically conductive matrix to improve the electrochemical performance of Fe(3)O(4).

Treatment of dyslipidemia in the elderly.

Dyslipidemia is a well-established risk factor for atherosclerosis. Treating dyslipidemia in elderly patients requires specific knowledge and understanding of common dyslipidemias and the relative safety of various pharmacologic agents in the presence of possible multiple comorbidities. Lifestyle modification remains the first step in the treatment of dyslipidemia; however, it can be difficult to sustain and achieve acceptable compliance in the elderly and it is best used in combination with drug therapy. Statins are widely accepted as the first-line therapy. Several recent studies have demonstrated that statins are safe and effective in the elderly. However, it is important to note that there is very limited data regarding the effects of dyslipidemia treatment on morbidity and mortality in patients over 85 years of age. In summary, the clinicians must recognize that the presence of dyslipidemia in the elderly poses substantial risk of coronary events and stroke. The available evidence has demonstrated that in most elderly patients who are at increased risk for cardiovascular morbidity and mortality, treatment of dyslipidemia with appropriate therapy reduces the risk, and when used carefully with close monitoring for safety, the treatment is generally well tolerated. With increasing life expectancy, it is critical for physicians to recognize the importance of detection and treatment of dyslipidemia in the elderly.

[Investigation on hantaviruses infection in rodents from free markets in Beijing areas].

OBJECTIVE: In order to find out the factors related to hemorrhagic fever with renal syndrome (HFRS) infection, and to evaluate the probability of ecdemic hantaviruses (HV) infection in rodents in Beijing areas. METHODS: Rodents were collected in a large-scale railway station and a produce market with 'trap nights' method from April to May, 2004. The IgG reacting sera to HV antigen were detected using ELISA. The partial M and S segment of HV from captured rodent lung samples were amplified with RT-PCR. The PCR products were purified and sequenced. BLAST program was then used to perform on nucleotide pairwise alignment with all available sequence in GenBank. The alignment of the multiply nucleotide and the deduced amino acid sequences, together with phylogenetic analysis were completed with DNASTAR software. RESULTS: The average population density was 3.49% (24/690). The overall seroprevalence of HV infection was 8.3% (2/24). RT-PCR positive rates were 8.3% (2/24). The nucleotide sequences of 356 bp region (1958 - 2313) of M segment obtained from 2 samples were all identified to Seoul virus (SEOV), with 7.6% heterogeneity. The dc501 strain from railway station was closely related to SD227 and Hebei4 from Shandong and Hebei provinces respectively. BjFT01 strain from the farm product market had more special nucleotide transitional mutations than other known SEOV from Beijing in GenBank. This strain, together with known HN71 from Hainan province, K24-E7 from Zhejiang province, L99 from Jiangxi province and R22 from Henan province, represented a monophylogentic linkage. CONCLUSION: The higher HV prevalence of rodents in transportation center was the potential and important risk for HFRS epidemic in Beijing. The increasing prevalence of M. musculus should call for attention. It was possible that SEOV in Beijing was imported by infected rodents through vehicles from other provinces.

[Study on the association between hantavirus infection and Rattus norvegicus].

OBJECTIVE: To further understand the association of hantavirus (HV) harbored and transmitted in wild brown rats. METHODS: Rattus norvegicus (n = 570) were trapped in 10 sites in Beijing. RT-PCR was used to test rodent lung samples for hantavirus infection. Unconditional multivariate logistic regression analysis was performed, with PCR positive as the dependent variable and the characteristics of Rattus norvegicus population as independent variables. RESULTS: The overall HV prevalence in Rattus norvegicus was 9.1% (52/570). Significant association between HV infection in Rattus norvegicus and some biological characteristics of host population was observed. Adult Rattus norvegicus had a higher HV prevalence than juveniles. Males in the reproduction periods and rats with wounds were more likely to be infected with HV than others. CONCLUSION: It was further confirmed that there existed parallel transmission of HV in Rattus norvegicus hosts. Aggression might be the primary mode of HV transmission among male Rattus norvegicus.