Prediction of surgical benefit in gastric cancer patients with peritoneal metastasis treated with hyperthermic intraperitoneal chemotherapy.

The objective is to evaluate whether gastric cancer patients with peritoneal metastasis can benefit from surgery through a comprehensive analysis of different clinical factors and perioperative treatment methods. A total of 135 gastric cancer patients with peritoneal metastasis were treated with Hyperthermic intraperitoneal chemotherapy (HIPEC). Patients were divided into either training group (without surgery, n = 90) or test group (with surgery, n = 45). A nomogram was constructed based on significant prognostic factors. The patients were divided into high- and low-risk groups using a nomogram. Overall survival were then compared according to whether surgery was performed in both groups. Alpha-fetoprotein (AFP), complications, conversion chemotherapy, and postoperative chemotherapy were significantly associated with overall survival (p < 0.05). A nomogram was constructed using the above four factors and validated using the test set. The area under the curve (AUC) of the model was 0.752 (95% CI 0.525-978). In the group that did not undergo surgery, the median survival times for the high-risk and low-risk groups were 7 and 11 months, respectively. In the surgery group, the median survival times for the high-risk and low-risk groups were 11 and 19 months, respectively. The difference was statistically significant (p < 0.0001). The four-factor nomogram can accurately predict high-risk and low-risk populations. Our findings suggest that cytoreductive surgery combined with HIPEC can improve the survival time of patients in both groups.

Efficacy of added splint therapy after arthrocentesis vs arthrocentesis alone in the management of temporomandibular joint disorders: a systematic review and meta-analysis.

OBJECTIVE: Occlusal splints are commonly used in the management of temporomandibular joint (TMJ) disorders (TMD). However, it is unclear if it should be used after a second-line therapy like arthrocentesis. We systematically reviewed the evidence on the efficacy of post-arthrocentesis splint therapy in the management of TMD. METHODS: PubMed, Embase, Scopus, Web of Science, CENTRAL, and Google Scholar were searched for studies published until 5th August 2024. The outcomes assessed were pain and maximal mouth opening (MMO). RESULTS: Eight studies were included. Five studies reported data for the meta-analysis. The pooled analysis found that there was no statistically significant difference in pain scores in the arthrocentesis + splint group vs arthrocentesis group at 1 month (MD: -0.01 95% CI: -0.46, 0.44), 3 months (MD: -0.02 95% CI: -0.67, 0.63) and 6 months (MD: 0.06 95% CI: -0.25, 0.37). The pooled analysis also showed that splint therapy after arthrocentesis may not significantly improve MMO as compared to no splint therapy at 1 month (MD: 0.08 95% CI: -2.11, 2.27), 3 months (MD: 0.76 95% CI: -0.84, 2.35) and 6 months (MD: 0.56 95% CI: -0.65, 1.78). Descriptive analysis of three studies showed that two supported the use of splints while one found no added improvement in outcomes. CONCLUSIONS: Limited evidence from low-quality studies shows that the use of splint therapy after arthrocentesis may not improve pain and MMO in patients with TMD. High-quality randomized controlled trials are needed to improve evidence.

Pan-cancer analysis of SERPINE1 with a concentration on immune therapeutic and prognostic in gastric cancer.

The serine protease inhibitor clade E member 1 (SERPINE1) is a key modulator of the plasminogen/plasminase system and has been demonstrated to promote tumor progression and metastasis in various tumours. However, although much literature has explored the cancer-promoting mechanism of SERPINE1, the pan-cancer analyses of its predictive value and immune response remain unexplored. The differential expression, and survival analysis of SERPINE1 expression in multiple cancers were analysed using The Cancer Genome Atlas and Genotype-Tissue Expression database. Kaplan-Meier (K-M) plotter and survival data analysis were used to analyze the prognostic value of SERPINE1 expression, including overall survival (OS), disease-specific survival, disease-free interval and progression-free interval and investigated the relationship of SERPINE1 expression with microsatellite instability. We further analysed the correlation between the expression of SERPINE1 and immune infiltration. The Kyoto Encyclopaedia of Genes and Genomes pathway was used for enrichment analysis, and the Gene Set Enrichment Analysis (GSEA) database was used to perform pathway analysis. Finally, in vitro experiments demonstrated that knockdown or overexpression of SERPINE1 could alter the proliferation and migration of gastric cancer (GC) cells. The results indicated that SERPINE1 expression levels different significantly between cancer and normal tissues, meanwhile, it was highly expressed in various cancers. By analysing online data, it has been observed that the gene SERPINE1 exhibits heightened expression levels across a variety of human cancers, significantly impacting patient survival rates. Notably, the presence of SERPINE1 was strongly associated with decrease OS and disease-free survival in individuals diagnosed with GC. Furthermore, an observed link indicates that higher levels of SERPINE expression are associated with increased infiltration of immune cells in GC. Finally, in vitro experiments showed that knockdown or overexpression of SERPINE1 inhibited the growth, and migration, of GC cells. SERPINE1expression potentially represents a novel prognostic biomarker due to its significant association with immune cell infiltration in GC. This study shows that SERPINE1 is an oncogene that participates in regulating the immune infiltration and affecting the prognosis of patients in multiple cancers, especially in GC. These findings underscore the importance of further investigating the role of SERPINE1 in cancer progression and offer a promising direction for the development of new therapeutic strategies.

Double Half Purse-String Sutures Plus "8" Pattern of Stitching for Prevention of Duodenal Stump Fistula after Laparoscopic Gastrectomy.

Background: Duodenal stump fistula represents an infrequent but serious complication after laparoscopic radical gastrectomy with Billroth II or Roux-en-Y reconstruction for gastric cancer. The present study was designed to evaluate the effectiveness of laparoscopic double half purse-string sutures plus "8" pattern of stitching for reinforcement of duodenal stump. Methods: The data of patients undergoing laparoscopic radical gastrectomy with Billroth II or Roux-en-Y reconstruction were retrospectively analyzed between August 2022 and June 2023. According to the different reinforcement methods of duodenal stump, included patients were subdivided into three groups as follows: Group A, duodenal stump was treated with double half purse-string sutures plus "8" pattern of stitching; Group B, duodenal stump was reinforced by continuous suture using a barbed suture; and Group C, duodenal stump without any additional processing. The incidences of duodenal stump fistula between three groups were documented and compared. Moreover, the independent risk factors associated with duodenal stump fistula were analyzed using the logistic regression analysis. Results: No postoperative duodenal stump fistula occurred in Group A, which was significantly different from Group B and Group C (P = .007). In the multivariate analysis, age (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.088-1.303), body mass index (OR, 0.824; 95% CI, 0.727-0.935), and American Society of Anesthesiologists score (OR, 4.495; 95% CI, 1.264-15.992) were the risk factors for duodenal stump fistula. Conclusion: Double half purse-string sutures plus "8" pattern of suture can be conducted in a relatively short operation period and could prevent the incidence of duodenal stump fistula to some extent.

Application value of hand-sewn anastomosis in totally laparoscopic total gastrectomy for gastric cancer.

BACKGROUND: Digestive tract reconstruction in totally laparoscopic total gastrectomy can be divided into two types: instrument anastomosis and hand-sewn anastomosis. This study explored the feasibility and safety of hand-sewn sutures in esophagojejunostomy of totally laparoscopic total gastrectomy, compared with instrument anastomosis using an overlap linear cutter. METHODS: This retrospective cohort study was conducted from January 2017 to January 2020 at one institution. The clinical data of 50 patients who underwent totally laparoscopic total gastrectomy, with an average follow-up time of 12 months, were collected. The clinicopathologic data, short-term survival prognosis, and results of patients in the hand-sewn anastomosis (n=20) and the overlap anastomosis (n=30) groups were analyzed. RESULTS: There were no significant differences between the groups in sex, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative complications, abdominal operation history, tumor size, pTNM stage, blood loss, first postoperative liquid diet, exhaust time, or postoperative length of hospital stay. The hand-sewn anastomosis group had a significantly prolonged operation time (204±26.72min versus 190±20.90min, p=0.04) and anastomosis time (58±22.0min versus 46±15.97min, p=0.029), and a decreased operation cost (CNY 77,100±1700 versus CNY 71,900±1300, p<0.0001). Postoperative complications (dynamic ileus, abdominal infection, and pancreatic leakage) occurred in three patients (15%) in the hand-sewn anastomosis group and in four patients (13.3%) in the overlap anastomosis group (anastomotic leakage, anastomotic bleeding, dynamic ileus, and duodenal stump leakage). CONCLUSION: The hand-sewn anastomosis method of esophagojejunostomy under totally laparoscopic total gastrectomy is safe and feasible and is an important supplement to linear and circular stapler anastomosis. It may be more convenient regarding obesity, a relatively high position of the anastomosis, edema of the esophageal wall, and short jejunal mesentery.

Digestive tract reconstruction of laparoscopic total gastrectomy for gastric cancer: a comparison of the intracorporeal overlap, intracorporeal hand-sewn anastomosis, and extracorporeal anastomosis.

BACKGROUND: The application of esophagojejunostomy has certain difficulties in totally laparoscopic total gastrectomy (TLTG). This is due to the higher requirement for surgical techniques and the lack of any unified standards. This study aim to explore the practicability and safety of intracorporeal overlap and intracorporeal hand-sewn anastomosis compared with extracorporeal anastomosis. METHODS: The clinical pathological data of 56 patients who underwent TLTG from March 2016 to December 2020 in the Harbin Medical University Cancer Hospital were retrospectively analyzed. According to the method of anastomosis, the patients were divided into the overlap (n=36) and the hand-sewn anastomosis (n=20). Patients who receive laparoscopic-assisted total gastrectomy (LATG; n=74) formed the control group. The basic clinical data, and intraoperative and postoperative results of the patients were assessed. RESULTS: Compared with the control group, the overlap anastomosis and hand-sewn anastomosis groups showed no significant differences in clinicopathological data and short-term postoperative recovery. There were no significant differences between the overlap and the control group in operation time nor anastomosis time. However, the anastomosis time of the hand-sewn anastomosis group was significantly prolonged compared to the control group (53.20±14.14 vs. 43.01±12.53 minutes, P=0.002). Compared with the control group, the operation cost was significantly higher in the overlap group (CNY 81,300±6,100 vs. CNY 76,600±6,800, P=0.001), but significantly lower in the hand-sewn anastomosis group (CNY 71,900±1,700 vs. CNY 76,600±6,800, P=0.003). Early postoperative complications occurred in 5 cases (13.9%) in the overlap group, 3 cases (15.0%) in the hand-sewn anastomosis group, and 11 cases (14.9%) in the control group. There were 3 cases (8.3%) of postoperative anastomotic-related complications in the overlap group. No anastomotic-related complications were observed in the hand-sewn anastomosis group. CONCLUSIONS: The overlap anastomosis and hand-sewn anastomosis are practical and safe. Furthermore, the overlap anastomosis may be more suitable for patients with lower cardia and fundic lesions. The hand-sewn method has a wider range of indications pending advanced surgical skills, and is an effective supplementary technique for instrument anastomosis.