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??Long-term outcomes of laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis in treating slow transit constipation WEI Dong, CAI Jian, ZHAO Ting, et al. Anus-Colorectal Surgery Institute of PLA, the 150th Central Hospital of PLA, Luoyang 471031,China
Corresponding author??WEI Dong, E-mail??wd150yyw5k@yeah.net
Abstract Objective To observe the long-term outcomes of laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (LSCACRA) in treating slow transit constipation (STC). Methods The clinical data of 40 patients with STC underwent LSCACRA between April 2007 and December 2009 in the 150th Central Hospital of PLA were analyzed retrospectively. The operation time, operation blood loss, first flatus time, hospital stay time and complications were analyzed. Preoperative and postoperative parameters of patients at 3rd, 6th, 12th, and 24th month were collected, including the Wexner constipation scale (WCS), gastrointestinal quality of life index (GIQLI). Results Laparoscopic operation was undertaken to all the patients without converting to open operation. There were two cases of incomplete ileus and two cases of pulmonary infection with Dindo>??. Comparing with the preoperative values, the values of WCS,GIQLI,AFIS and ABS at 3rd, 6th, 12th and 24th month after operation improved significantly (P<0.001). APIS didn't improve at 3rd and 6th month after operation comparing with the preoperative value (P>0.05), while the results at 12th and 24th improved significantly (P<0.05). Conclusion LSCACRA is a safe and effective operation method, which has a significant effect in the treatment of STC and notably relieves symptoms, nutritional status and quality of life of patients, presenting small wounds and faster recovery.     

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??Preoperative diagnosis of the malignancy for pancreatic cystic neoplasms FU De-liang. Department of Pancreatic Surgery of Huashan Hospital; Pancreatic Disease Institute; Shanghai Medical College, Fudan University, Shanghai 200040, China
Abstract Pancreatic cystic neoplasms (PCN) are being increasingly detected due to widespread use of abdominal imaging and improved imaging techniques. The most common types of PCN are serous cystic neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal papillary mucinous neoplasms (IPMN)and solid pseudopapillary neoplasm(SPN). Diagnosis of malignancy in PCNs cases requires radical pancreatectomy. Clinical?? radiological and laboratory characteristics of PCNs may predict underlying malignancy, including male sex, abdominal mass, weight loss, larger tumor size, local invasion, and elevated CA19-9. Recent developments of clinical, radiological, and laboratory modalities used for preoperative diagnosis and differential diagnosis of PCNs are provided this review. Analysis of DNA mutations, microRNA and proteins within pancreatic cyst fluid by EUS-FNA have identified potential biomarkers to aid with the management of patients with pancreatic cystic neoplasms.     

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??Objective??To investigate the clinical features??diagnosis??treatment and prognosis of eosinophilic cystitis in pediatric population. Methods??The records of four patients who had been diagnosed and treated for eosinophilic cystitis from January 2012 to May 2015 in Shengjing Hospital were retrospectively reviewed. Results??All the four patients were boys whose age ranged from 6 to 8 years. The main symptoms of the 4 cases were frequent micturition??odynuria??dysuria??suprapubic pain and hematuria.All of the 4 cases had significant peripheral eosinophilia and increased bladder wall thickness. All of the patients were diagnosed with biopsy. Bladder interstitial eosinophil infiltration was revealed by histopathology. The clinical symptoms??peripheral eosinophilia and bladder imaging changes were relieved after steroids and antihistamines treatment. Three cases developed recurrence. Total course of oral corticosteroids ranged from 3 months to 18 months. One case remained persistent remission for 2 years??two cases had are recurrence and one case had two recurrences. Conclusion??Bladder biopsy is essential to establishing the diagnosis of eosinophilic cystitis. Patients with peripheral eosinophilia and the increased bladder wall thickness should be considered with eosinophilic cystitis. Steroids is effective as medical therapy for eosinophilic cystitis and close long-term follow-up is necessary.     

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??Objective To investigate the clinical characteristics and treatment of hypereosinophilic syndrome??HES?? in children. Methods The clinical manifestations?? laboratory examinations??gastroscopy and imaging features??pathological results and therapy experience in 13 HES children admitted in Beijing Children’s Hospital??Capital Medical University from January 2009 to February 2016 and related literatures were analyzed retrospectively. Results Of the 13 patients evaluated?? 7 were male??54%?? and 6 were female??46%??. The median age at diagnosis was 9.6 years old??ranging 3 to 14 years old??. The median course of disease was 23 months??ranging 1 to 72 months??. The peripheral eosionophil counts ranged ??4.5—29.2??×109/L??mean 13.5×109/L??. Gastrointestinal tract was the most commonly involved organ?? and was reported in 92%??12/13?? of patients. It was followed in frequency by urinary system??84%????pulmonary??53%????cardiac??23%????and skin??8%?? and liver??8%??. A total of 2 sites were involved in 6 patients??3 sites were involved in 5 patients and 4 sites were involved in 2 patients. Treatment of oral prednisone therapy was given and follow-up of 10 patients had no clinical symptoms??2 patients had stopped prednisone??. But eosionophil counts still increased to varying degrees. Three patients were lost to follow-up. Conclusion HES in children is more common in school age and adolescent children. Gastrointestinal tract??urinary system and pulmonary involvement are more common. Glucocorticoid treatment is effective??which requires to be maintained in small dose in the long term.     

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??Comparison of the efficiency between two methods of alimentary tract reconstruction after robot-assisted total gastrectomy for gastric cancer DIAO Yan-qing, WANG Zhi-ming, JIANG Zhi-wei, et al. Research Institute of General Surgery of PLA, Nanjing General Hospital of Nanjing Military Region, Nanjing 210002, China
Corresponding author??JIANG Zhi-wei, E-mail??surgery34@163.com
Abstract Objective To compare the feasibility and difficulty between two methods of alimentary tract reconstruction after robot-assisted total gastrectomy for gastric cancer. Methods From April 2012 to April 2015??57 patients with gastric cancer in Nanjing General Hospital of Nanjing Military Region were enrolled for robot-assisted total gastrectomy and reconstruction of digestive tract??and all the operations were performed by the same surgeons. In 35 patients (group A)??reconstruction of alimentary canal was performed using single needle running by an absorbable suture. In the other 22 patients (group B), it was performed using two needle running by a barbed suture (180 Polyglyconate Absorbable Knotless Wound Closure Device). Several parameters were evaluated and compared in the two groups, such as time of operation, time of anastomosis, length of hospital stay, and the incidence rate of postoperative complications. In addition??the difficulty of anastomosis was assessed by the surgeon. Results All the 57 robot-assisted operations were completed successfully without conversion to open surgery. In group A??the total time of surgery was ??251.3±64.4??min??time of esophagojejunostomy was ??37.8±11.6??min??time of jejunojejunostomy was ??29.4±8.7??min??the time of postoperative hospital were ??5.5±3.7??days. In group B??the total time of surgery was ??192.8±52.9??min??time of esophagojejunostomy was ??18.1±7.9??min??time of jejunojejunostomy was ??14.6±6.3??min??the time of postoperative hospital were ??4.7±4.1?? days. Compared with group A??group B represented reduced difficulty in both operation and cooperation??significantly shorter time of the anastomosis?? surgery and postoperative hospital stay??P??0.05??. Furthermore??in group A there were two patients with anastomotic complications (anastomotic stricture)??but in group B they had declined (2/35 vs.0/22). Conclusion Both two kinds of anastomosis for alimentary canal reconstruction in robotic total gastrectomy are safe and feasible. The use of the barbed suture in totally robotic total gastrectomy would reduce the difficulty of reconstruction of digestive tract and save a lot of time of anastomosis??surgery and postoperative hospital stay.     

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??Efficacy of FOLFOX4 regimen systemic chemotherapy in treating advanced hepatocellular carcinoma: An analysis of 22 cases YIN Xiao-yu*??CHEN Jie??PENG Jian-xin??et al. *Department of Hepatobiliary Surgery??the First Affiliated Hospital of Sun Yat-sen University??Guangzhou 510080??China
Corresponding author??YIN Xiao-yu??E-mail??yinxy@21cn.com
Abstract Objective To evaluate the efficacy of FOLFOX4 regimen systemic chemotherapy in treating advanced hepatocellular carcinoma (HCC). Methods The clinical data of 22 cases of advanced HCC were treated by FOLFOX4 regimen systemic chemotherapy between July 2007 and July 2013 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. The chemotherapy was given each two weeks??with a maximum of 8 cycles. The therapeutic responses were evaluated each 3 cycles and end of treatment. Results A total of 85 cycles were administered in 22 cases??with a mean of ??3.7±2.0?? cycles /case. There were no complete response??5 partial responses??5 static diseases and 12 progressive diseases. The objective response rate was 22.7% (5/22)??and disease control rate was 45.4% (10/22)??with a one-year survival rate of 12.1% and median survival time of 5.8 months in the follow up of 2-34 ??8.5±1.9??months . In 10 cases of disease control after chemotherapy??the median survival time reached up to 9.5 months. Conclusion FOLFOX4 regimen systemic chemotherapy is effective in part of advanced HCC??and represented as an effective modality.     

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??Chimney technique for aortic diseases involving supra-aortic branches in a single center SHU Chang, WANG Tun. Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, China
Corresponding author: SHU Chang, E-mail??changshu01@yahoo.com
Abstract Objective To evaluate the mid- and long-term efficiency of thoracic endovascular aortic repair (TEVAR) with chimney technique for aortic arch disease involving the supra-aortic branches. Methods The clinical data of 57 cases of aortic arch diseases performed TEVAR with chimney technique from September 2009 to December 2013 in Department of Vascular Surgery, the Second Xiangya Hospital, Central South University were analyzed retrospectively. There were 2 cases (3.5%) of aortic arch aneurysm, 1 case (1.8%) of type I endoleak after TEVAR for thoracic aortic aneurysm, 1 case (1.8%) of type I endoleak after TEVAR for type B aortic dissection (TBAD), 53 cases (92.9%) of TBAD. One case was complicated with Marfan syndrome. Results All of the stent grafts were deployed as planned. Five cases had type II endoleak during TEVAR. One case received re-TEVAR and another chimney stent grafts deployment because of ischemia of branch arteries caused by migration of chimney stent grafts during anesthesia resuscitation. All patients followed up for 2 to 51 months. One case of TBAD received re-TEVAR for distal re-entry. One case died of cerebral hemorrhage 3 months later. No TEVAR related complications happened, such as stent graft migration, occlusion, fracture or type I endoleak during follow-up. Conclusion Chimney technique can be used with TEVAR to treat aortic arch disease invaded supra-aortic branches, which is reliable and stable. Reconstructed supra-aortic branches with covered stent is useful for prevention of post-TEVAR complications     

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??Abstract?? Objective To study balloon dilatation with cryotherapy under bronchoscope for subglottic stenosis in infants and young children??and to explore the efficacy of this new technology??the timing of treatment and safety. MethodFrom July 2009 to May 2014 in 28 SGS cases aged from 1 month to 3 years?? bronchoscopic balloon dilatation treatment with CO2 cryotherapy was performed?? and different types of SGS treated by minimal invasi were assessed regarding efficacy, complications and outcome. Results The infant SGS were divided into ??°~??° by severity?? and soft membrane SGS and scarring SGS by the causes of stenosis. ??° SGS included 16 cases, in which 8 cases soft membrane SGS were treated by balloon dilatation effectively?? 9 cases after combined treatment; in scarring SGS balloon dilatation was effective in 1 case?? 4 cases after combined therapy; ??° SGS included 8 cases?? soft membrane SGS were treated effectively in 2 cases?? 4 cases after combined treatment; in scarring SGS balloon dilatation was effective in 1 case?? 2 cases after combined therapy; ?? °SGS included 4 cases?? 1 case of soft membrane SGS and 1 case of scarring SGS responded well to integrated treatment .Conclusion MSCT and bronchoscopy assessment is used in grading the extent and causes of stratification in infants with subglottic stenosis?? and then we can select the appropriate treatment programs to improve the prognosis of the disease and improve life quality of SGS children.     

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??Abstract??The fifth edition of Diagnostic and Statistical Manual of Mental Disorders ??DSM-???? is released in May 2013.The new term of autism spectrum disorder ??ASD?? replaced the term of pervasive developmental disorder ??PDD??.In this paper??the background for the current definition of ASD??the major changes of DSM-?? in ASD??the possible effects on the clinical practice of diagnosis and treatment of autism??and the continuous debate on this topic will be reviewed.     

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??Prevalence and temporal trend of gallbladder cancer in Shanghai ZHANG Ming-di*,GONG Wei, ZHENG Ying, et al.*Department of General Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092,China
Corresponding author: QUAN Zhi-wei, E-mail:zhiwquan@yahoo.com.cn; GONG Wei, E-mail: gongweius@hotmail.com
Abstract Objective To analyze the epidemiological pattern of gallbladder cancer in Shanghai. Methods The data of gallbladder cancer incidence in Shanghai were collected by the Shanghai cancer registry center and the trend of the incidence in urban Shanghai population from 1973 to 2006 was assessed by using the annual percent change (APC) analysis, which were compared with epidemiological data from other countries. Results A total of 5 253 new cases of gallbladder cancer were diagnosed from 2002 to 2006 with a crude incidence of 7.81 per 100,000 and an age-adjusted incidence of 3.80 per 100,000. Gallbladder cancer ranked the fifteenth among the common cancer in the male and ranked the eleventh in the female. The male/female incidence ratio was 1:1.77. In the age group of below 70 years, incidence is higher in the rural area than that in the urban area. But in the group of over 70 years, that is on the contrary. Of all the patients, 75.1% was over 65 years old and the highest incidence was observed in the age group of 80-84 years. The age-adjusted incidence rates have increased by 141.1% and 137.6% in the male and the female from 1973 to 2006 in urban Shanghai respectively. Conclusions The incidence of gallbladder cancer in the Shanghai area is obviously beyond the middle level of the world. Comprehensive screening of high-risk groups might be the only effective population-based preventive measure of the gallbladder cancer.