[Real-world data analysis of 3012 patients undergoing laparoscopic radical gastrectomy in a single center over the past 12 years].

Objective: To Summarize the safety, clinical outcome and technical evolution of laparoscopic gastric cancer surgery. Methods: A retrospective cohort study was carried out. Clinical data of 3012 patients who underwent laparoscopic radical gastrectomy for gastric cancer from January 2010 to March 2022 at Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University were retrospectively collected and analyzed. Case inclusion criteria were gastric malignancies confirmed by pathology, without distant metastasis by examination before operation and exploration during operation, patients undergoing laparoscopic radical gastrectomy, intact function of important organs and with complete data. Exclusion criteria were patients who underwent emergency gastric cancer resection due to gastric bleeding, perforation or obstruction, etc., tumor found to invade adjacent organs such as pancreas or transverse colon during the operation, conversion to open surgery during the operation, those who had other malignant tumors (except thyroid cancer) within 5 years, and those had severe cardiopulmonary, liver, or kidney insufficiency before surgery. Outcomes included: (1) baseline information of patients; (2) trend of the quantity of laparoscopic radical gastrectomy year by year; (3) evolution of the mode of digestive tract reconstruction; (4) periopertive outcome short-term complication was defined as complication occurring within 30 days after operation and classified accordiny to the clavien-Dindo criteria; and (5) 5-year overall survival. SPSS software was used for statistical analysis. Continuous variables that obeyed the normal distribution were expressed in the form of Mean±SD. Days of hospital stay that did not follow a normal distribution were expressed as median (Q1,Q3), and the Mann-Whiney U test was used for comparison. Discrete variables were expressed as cases (%), and chi-square test or rank sum test was used for comparison between groups. Linear regression analysis was used to analyze the relationship between the amount of surgery and the year of surgery. Kaplan-Meier method and log-rank test were used for survival analysis. Two-tailed P<0.05 was considered as statistically significant. Results: Among the 3012 cases, 2114 were male and 898 were female. The patients' average age at surgery was (61.1±10.7) years old. According to the number of cumulative cases, the patients were divided into three groups: early, intermediate and late, with 1004 patients in each group. The early group consisted of patients undergoing operation from January 2010 to October 2018, the intermediate group consisted of patients undergoing operation from October 2018 to January 2021, and the late group consisted of patients undergoing operation from January 2021 to March 2022. (1) General information: There were 691 (68.8%), 699 (69.6%) and 724 (72.1%) male patients in early, intermediate and late groups respectively; the average age increased from 56.6 years in 2010 to 62.8 years in March 2022. As for the tumor stage T1, T2, T3, T4, there were 49.0%, 14.4%, 23.9% and 12.6% in the early group; 47.5%, 12.9%, 26.9% and 12.6% in the intermediate group; 39.7%, 14.6%, 30.0%, and 15.6% in the late group, respectively. Patients with N0, N1, N2, N3a, N3b stage were 56.8%, 13.7%, 13.4%, 11.0%, and 5.0% in the early group; 55.7%, 12.9%, 12.8%, 11.6%, and 6.9% in the intermediate group; 51.0%, 16.1%, 12.8%, 12.5%, and 7.5% in the late group, respectively. (2) Year-by-year change in the number of gastric cancer operations: From 19 cases per year in 2010 to 786 per year in 2021, the annual number of gastric cancer operations was proportional to the year of operation (y=47.505x, R2=0.67). The proportion of patients with stage I disease showed a fluctuating downward trend over time, while the proportion of patients with stage III disease increased slightly, accounting for 34% until March 2022. (3) Evolution of digestive tract reconstruction methods: Except in 2010, the digestive tract reconstruction method of distal gastrectomy focused on Billroth-II+Braun anastomosis among patients undergoing laparoscopic gastric cancer surgery in other years, whose proportion had gradually increased from less than 20% in 2016 to about 70% after 2021; the gastrointestinal reconstruction methods after total gastrectomy had gradually increased in π anastomosis and overlap anastomosis since 2016, of which π anastomosis reached about 65% in 2019, and overlap anastomosis reached almost 30% in 2020; the anastomosis methods after proximal gastrectomy had been mainly double-channel anastomosis (54%) and esophagogastric anastomosis (30%) since 2016, and double-channel anastomosis accounted for up to 70% in 2019. (4) Operation time: The operation time of early, intermediate and late group was (193.3±49.8) min, (186.9±44.3) min and (206.7±51.4) min respectively. Intermediate group was significantly shorter than early group (t=3.005, P=0.003), while late group was significantly longer than early group (t=5.875, P<0.001) and intermediate group (t=9.180, P<0.001). (5) Postoperative hospital stay: The median length of hospital stay for gastric cancer patients in early, intermediate and late groups was 9 (8, 11) d, 8 (7, 10) d, and 8 (7.5, 10) d respectively. The postoperative hospital stay of intermediate group and late group was significantly shorter than that of early group (Z=-12.467, Z=-5.981, both P<0.001), but there was no significant difference between intermediate group and late group (Z=0.415,P=0.678). (6) Postoperative complication: The morbidity of short-term complication in early, intermediate and late group was 20.4% (205/1004), 16.2% (163/1004), and 16.2% (162/1004) respectively, and above morbidity of intermediate group and late group was significantly lower than that of early group (χ2=5.869, P=0.015; χ2=6.165, P=0.013), while there was no significant difference between intermediate group and late group (χ2=0.004,P=0.952). The morbidity of short-term complication of grade IIIor higher was 8.0% (80/1004), 7.6% (76/1004), and 4.9% (49/1004) in early, intermediate and late group respectively, and above morbidity of late group was significantly lower than that of early and intermediate group (χ2=7.965, P=0.005; χ2=6.219,P=0.013), while there was no significant difference between intermediate group and early group (χ2=0.111,P=0.739). (7) Survival analysis: The follow-up deadline for survival data was December 31, 2021, and the median follow-up time was 29.5 months. The overall 5-year survival rate of all the patients was 74.7%. The 5-year survival rates of stage I, II and III patients were 92.0%, 77.2%, and 40.3% respectively and 5-year survival rates of patients with stage IA, IB, IIA, IIB, IIIA, IIIB and IIIC were 93.2%, 87.8%, 81.1%, 72.7%, 46.2%, 37.1%, and 34.0% respectively. Conclusions: The number of laparoscopic gastric cancer operation in our center is increasing year by year. With the maturity of laparoscopic technology, the morbidity of complication in laparoscopic gastric cancer surgery is decreasing.

CLOSED FEMORAL NAILING WITH THE TECHNIQUE OF USING A NEW FEMORAL DISTRACTOR: A PRELIMINARY REPORT.

This study introduces the application of a new femoral distractor in the treatment of femoral fracture restoration with internal fixation of intramedullary nail. Sixty-three patients with femoral fracture from the Affiliated Hospital of Binzhou Medical University underwent femoral facture restoration with the new femoral distractor in combination with internal fixation of an intramedullary nail from June 2011 to March 2014. There were 18 cases of proximal femur fractures, 44 cases of middle femoral shaft fractures and 1 case of distal femur fracture. Follow-up was on the 4th, 6th, 8th, 12th, 16th and 24th week after operation. All 63 patients successfully underwent the surgery and the steel needles used did not cause injury to the adjacent vessels or nerves. Five cases had to have steel needles reinserted, as they had failed in the distraction reduction due to being unsteadily fixed because of an improper position. Patients were followed up for 10~24 months (mean 16 months), and the total healing rate was 100%. Operative time was 93.5 minutes averagely. Average time of patients’ exposure to X-ray was 26.8 seconds. Bleeding volume was averagely 219.1 ml. There were no complications either during the operations or after them. All cases healed within 12 weeks (average 7.6 weeks). This study proves that, the new femoral distractor can help the closed reduction of fractures in treating femoral fractures with intramedullary nails to avoid the inconvenience of applying traction tables and the occurrence of potential complications.

cDNA cloning and mRNA expression of a tandem-repeat galectin (PoGal2) from the pearl oyster, Pinctada fucata.

Galectins can recognize and specifically bind to ß-galactoside residues, playing crucial roles in innate immune responses of vertebrates and invertebrates. We cloned the cDNA of a tandem-repeat galectin from the pearl oyster Pinctada fucata (designated as PoGal2). PoGal2 cDNA is 1347 bp long and consists of a 5'-untranslated region (UTR) of 3 bp, a 3'-UTR of 297 bp with one cytokine RNA instability motif (ATTTA), and an open reading frame of 1047 bp, encoding a polypeptide of 349 amino acids, with an estimated molecular mass of 38.1 kDa and a theoretical isoelectric point of 8.5. PoGal2 contains two carbohydrate recognition domains (CRDs); both have the conserved carbohydrate-binding motifs H-NPR and WG-EE. PoGal2 shares 50.6 and 50.9% identity with those of abalone (Haliotis discus) and the Manila clam (Venerupis philippinarum), respectively. Phylogenetic analysis revealed that the tandem-repeat galectins formed two clades for the different species. Molluscan tandem-repeat galectins were clustered into a single clade, and nematode tandem-repeat galectins were clustered into another single clade. In both clades, CRD-N and CRD-C were divided into different groups. PoGal2 mRNA was constitutively expressed in all tissues analyzed, and the expression level of PoGal2 mRNA was found to be significantly up-regulated in digestive glands, gills and hemocytes after Vibrio alginolyticus stimulation/infection. Expression profile analysis showed that the expression level of PoGal2 mRNA was significantly up-regulated at 8, 12 and 24 h after V. alginolyticus infection. These results suggest that PoGal2 is a constitutive and inducible acute-phase protein involved in the innate immune response of pearl oysters.

Pharmacokinetics, tissue distribution, and metabolism of novel DNA topoisomerase I inhibitor yuanhuacine in rabbit.

A liquid chromatography/tandem mass spectrometry method was developed and validated for the quantitative determination of yuanhuacine (YHC), a daphne diterpene ortho-ester anticancer agent, and identification of its metabolites. Pharmacokinetic behaviour, tissue distribution, and metabolism were investigated in rabbit. YHC plasma data best fitted to a two-compartment model and were characterized by an elimination half-life t(1/2)(beta) of 11.1 h following intravenous administration. Tissue distribution studies did not identify any tissues having a high affinity for YHC. The main metabolites are proposed to be M392I, M392II, and M390, resulting from the ortho-ester group and aromatic ester bond being cleaved off simultaneously during Phase I metabolism. This investigation contributes to an understanding of the metabolism of daphne diterpene ortho-esters.

Determination of microstickies in recycled whitewater by headspace gas chromatography.

This study proposed a novel headspace gas chromatographic (HS-GC) method for determination of adhesive contaminants (microstickies) in recycled whitewater, a fiber containing process stream, in the paper mill. It is based on the adsorption behavior of toluene (as a tracer) on the hydrophobic surface of microstickies, which affects the apparent vapor-liquid equilibration partitioning of toluene. It was found that the equilibrium concentration of toluene in the vapor phase is inversely proportional to the apparent effective surface area of microstickies that remain in the corresponding solution. Thus, the amount of microsticky materials in the recycled whitewater can be quantified by HS-GC via indirect measurement of the toluene content in the vapor phase of the sample without any pretreatment. The presented method is simple, rapid and automated.

Cytotoxity of non-alkaloidal taxane diterpenes from Taxus chinensis against a paclitaxel-resistant cell line.

Seven taxane diterpenes were isolated from the EtOH extract of the aerial parts of Taxus chinensis, and evaluated for cytotoxicity against nine human cell lines, including a beta-tublin mutant resistant to paclitaxel. Compound 2, a non-alkaloid-type taxane diterpene, showed significant cytotoxicity in most cell lines, and notably, equipotent against both parental and beta-tublin mutant tumor cell lines.

Antitumor agents--CLI. Bis(helenalinyl)glutarate and bis(isoalantodiol-B)glutarate, potent inhibitors of human DNA topoisomerase II.

Evaluation of a number of cytotoxic antitumor sesquiterpene lactones and their derivatives has led to the discovery of bis(helenalinyl)glutarate (4) and bis(isoalantodiol-B)glutarate (10) as potent inhibitors of human-derived topoisomerase II. Unlike etoposide, which inhibits by preventing the DNA rejoining process, compounds 4 and 10 inhibit topoisomerase II without causing DNA breakage. The structure-activity relationships of 4, 10, and related compounds are discussed.

Antitumor agents, 145. Cytotoxic asprellic acids A and C and asprellic acid B. new p-coumaroyl triterpenes, from Ilex asprella.

Three new p-coumaroyl triterpenes, asprellic acids A [1], B [2], and C [3], were isolated from the EtOH extract of dried leaves of Ilex asprella. The structures for 1-3 have been established as 3,27-di-O-trans-p-coumaroyl [1], 3-O-trans-p-coumaroyl-27-O-cis-p-coumaroyl- [2], and 3-O-cis-p-coumaroyl-27-O-trans-p-coumaroyl- [3] 3 beta,27-dihydroxyolean-12-en-28-oic acid, respectively, by spectral and chemical examinations. Asprellic acid A [1] exhibited potent cytotoxicity against the RPMI-7951 cell line with an ED50 value of 0.62 micrograms/ml, while the cytotoxicity of asprellic acid C [3] against RPMI-7951 was marginal (ED50 5.5 micrograms/ml). Compounds 1 and 3 also showed cytotoxicity against KB cells with ED50 values of 3.75 and 2.86 micrograms/ml, respectively. Asprellic acid B [2] did not show cytotoxicity (> 10 micrograms/ml) against KB or RPMI-7951 cell lines.

Yuanhuacin A is a selective antagonist of phorbol ester receptor in protein kinase C.

Protein kinase C with a molecular weight of 82 kD has been purified to electrophoresis homogeneous from rat brain through a series of chromatography columns including DE-52, Sepharose G-200 and phenyl-Sepharose. The enzyme possessed autophosphorylation activity. Yuanhuacin A inhibited the 3H-phorbol-12, 13-dibutyrate (3H-PdBu) binding of PKC with an IC50 value of 1.48 +/- 0.28 x 10(-8) mol/L when the concentration of 3H-PdBu was 1.5 x 10(-9) mol/L (Ki = 1.2 x 10(-8) mol/L). Yuanhuacin A inhibited the PdBu-stimulated PKC activity in the catalysis of the phosphorylation of Histone III-S with an IC50 of 2.82 +/- 0.37 x 10(-9) mol/L (PdBu = 10(-6) mol/L), while it had no effect on the basal and Ca(2+)-stimulated PKC activity in the same assay system. This result suggests that Yuanhuacin A is a selective antagonist of the phorbol ester receptor in protein kinase C.

[Hassab's procedure with or without lower esophageal transection in the treatment of portal hypertension. A prospective controlled study].

Seventy-three patients of portal hypertension were treated with Hassab's procedure or the procedure combined with lower esophageal transection during 1982-1986. All were followed up to 25-74 months (average of 48.8 months). The results revealed that Hassab's procedure was effective in maintaining hepatic function, no encephalopathy, good quality of life (excellent and fair in 83.3%). low incidence of upper GI rebleeding within two years after operation (3.1%), and easy manipulation. However, the accumulated late rebleeding rate was rather high (18.8%). The long-term results of combined procedure, including rebleeding rate, was no significantly difference from those of the simple Hassab's procedure, and the early postoperative serious complications were more frequently seen in patients receiving combined procedure than in those receiving Hassab's procedure.

[Early treatment of third degree burns of the entire hand].

Treatment and result of burned total hand was reported here in 4 hands (4 cases). According to the treatment and anatomical characteristics, burned hand was divided into 4 areas: dorsum of hand, dorsum of finger, thenar-wrist area and volar-digit area. The treatment of total hand in third degree burns included emergency escharotomy of hand and digits, early escharotomy and immediate skin grafting on the dorsum of hand, thenar-wrist and volar-digit area. But on the dorsum of digit area this sort of hand was often deepen to the phalangeal bones and joints. After healing of early graft, the exposed bones and joints were decorticated with immediate grafting on the fresh bone marrow surface and with the finger tip repair so as to preserve the length of digits. When the bone marrow surface grafting healed metallic finger splints were bent sequentially to functional position for 8 weeks in order to ankylosis of interphalangeal joints. Followed up 4 hands with good results. And only 5 distal phalanges were loss in 20 digits. But in previous cases this kinds of digits were often amputated with poor results.

Morphopathologic observations on high-velocity steel bullet wounds at various intervals after wounding.

Soft-tissue wounds of both hind legs in 15 dogs were inflicted by spherical steel bullets. Histologic and ultrastructural changes were observed in the contusion zone and the concussion zone at 6, 12, and 24 hr after wounding. Histologically, it was shown that at 6 hr after wounding, there were degeneration and necrosis of myofibers and interstitial hemorrhage and edema in the contusion zone, while some fibers still appeared to have normal structure in the outer layers. In the inner layers of the concussion zone close to the entrance, there was focal necrosis of myofibers. Histologic changes at 12 and 24 hr after wounding were similar to those at 6 hr but there were more inflammatory reactions. A considerable number of ultrastructural changes were seen in the contusion zone at 6 hr after wounding, such as loss of sarcomeres, vacuolization and pyknosis of mitochondria, swelling of sarcoplasmic reticulum, irregular arrangement of Z-lines, breaking of some capillary endothelial cells, etc. However, in the concussion zone, the changes were much less than those above mentioned, although karyons and karyomeres of some monocytes appeared to be gathering to the side of cytoblast. On the whole, the ultrastructural changes were not so severe at 12 and 24 hr as those at 6 hr after wounding. Also, the characteristic features of the wound caused by high-velocity steel bullets were not similar to those caused by 5.56-mm high-velocity missiles. The severity of damage at the entrance of wound track caused by steel bullet was more marked than that at the exit.

[Evaluation of CT scan for carcinoma of the gastric cardia].

CT scans of 50 cases with carcinoma of gastric cardia were analyzed. 45 cases were operated but 12 were explored only. The causes of unresectability were: bulky primary tumor, regional lymph node involvement, infiltration of the adjacent structures, e.g. liver, pancreas, spleen and diaphragm, intragastric extension and ascites. By CT scan, the detection rate of the visceral organ involvement was: diaphragm 4/7, pancreas 3/10, liver 4/6 and spleen 5/6. Therefore, it is very important to have a preoperative CT scan for carcinoma of gastric cardia.