Clinical analysis of salvage surgery after noncurative endoscopic resection for early gastric cancer / 中华普通外科杂志

Objective:To evaluate salvage surgery in patients with early gastric cancer after noncurative endoscopic resection .Method:A total of 56 cases with early gastric cancer receiving salvage surgery after noncurative endoscopic resection were enrolled and the clinicopathological and follow-up information were analyzed to evaluate the necessity and safety of salvage surgery.Results:Among the 44(79%)patients with submucosal invasion, 38 (68%) were with SM2 (invasion submucosal invasion≥500 μm) according to the pathological results after endoscopic resection. 33 (59%)cases had positive margin. The rate of lymph node metastasis and positive residual tumor as found by salvage gastrectomy were 11% (6/56) and 25% (14/56) . In the multivariate analysis, deeper submucosal invasion resulted as independent risk factor for residual tumor( OR=1.001, 95% CI=1.000-1.002, P=0.036). Among the 12(21%)cases with postoperative complications, 3 (5%)underwent unplanned reoperations because of anastomotic or intra-abdominal bleeding. There was no difference in the number of retrieved lymph nodes and rate of postoperative complications between laparoscopic and open surgery(all P>0.05). Conclusion:For patients with the risk factors of lymph node metastasis after noncurative endoscopic resection, salvage surgery was necessary and laparoscopic approach was safe and feasible.

The therapeutic strategy after noncurative endoscopic submucosal dissection for early gastric cancer / 中华肿瘤杂志

Objective@#To investigate the therapeutic strategy in patients with early gastric cancer after noncurative endoscopic submucosal dissection (ESD).@*Methods@#A total of 107 cases with early gastric cancer receiving noncurative endoscopic submucosal dissection were collected and the patients were classified into an additional gastrectomy group (n=41) and a simple follow-up group (n=66) according to the therapeutic method used after noncurative ESD. The clinicopathological information, short- and long-term clinical outcomes between the two groups were analyzed and compared.@*Results@#The mean age of the patients in the gastrectomy group and follow-up group was(59.2±8.7)years old and(64.7±8.8)years old, respectively. The depth of submucosal invasion was (1445.83±803.12) and (794.71±815.79) μm, respectively. The difference between the two groups was statistically significant (P=0.020 for age and P=0.010 for depth of submucosal invasion). Compared with follow-up group, the patients with undifferentiated histologic type, deep invasion of submucosa (SM2), diffuse type, lymphovascular invasion and neural invasion were more common in the gastrectomy group (P<0.05). The R0 resection rate of ESD in the gastrectomy group was significantly lower than the follow-up group(26.8% vs 65.2%, P<0.001). The positive residual tumor rate and LNM rate of additional gastrectomy group were 31.7%(13/41)and 9.76%(4/41)according to the pathological results after gastrectomy. The gastrectomy group had 2 cases of local recurrence (2/41, 4.9%), while 5(5/66, 7.6%)in the follow-up group(4.9% vs 7.6%, P=0.883). There was no significant difference in overall survival (OS) and disease-free survival (DFS) between the two study groups (P=0.066 and 0.938, respectively).@*Conclusions@#Assessment of LNM risk should be performed in patients with noncurative endoscopic resection. For patients with low risk of LNM who are intolerance of additional gastrectomy due to old age and comorbidities, close follow-up with endoscopy can be considered as an alternative.

Impact of previous abdominal surgery on the outcomes of laparoscopic resection for colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of previous abdominal surgery(PAS) on laparoscopic resection of colorectal cancer.</p><p><b>METHODS</b>The retrospective cohort study was adopted.Clinical data of consecutive colorectal cancer patients with PAS history (past history of at least one abdominal surgery, exclusion of previous inguinal hernia repair, simple laparoscopic approach, appendectomy of the right lower quadrant and endoscopic therapy) undergoing laparoscopic surgery at the Cancer Hospital of Chinese Academy of Medical Sciences between 2010 and 2015 were collected, meanwhile other colorectal cancer patients without PAS history were selected according to 1 to 1 match in age, sex, body mass index, American Society of Anesthesiologists score, tumor location, type of surgery, and staging of tumor. A total of 464 pairs were successfully matched. Intraoperative and postoperative conditions, perioperative complications and prognosis were compared between the two groups.</p><p><b>RESULTS</b>In PAS group, there were 341 males (73.5%) and 123 females (26.5%) with a median age of 62 (24-85) years; 317(68.3%) cases with only one previous abdominal surgery and 147(31.7%) with more than one; 389(83.8%) cases with abdominal midline incisions, 37(8.0%) with transverse incisions, 34(7.3%) with right subcostal incision and 4(0.9%) with left subcostal incision; 146(31.5%) cases undergoing gynecologic surgery, 84(18.1%) cholecystectomy, 52(11.2%) gastroduodenal surgery, 89(19.2%) colorectal surgery, 11(2.4%) small intestine surgery, 23(5.0%) hapatectomy, 16(3.4%) pancreatic surgery, 8(1.7%) urological surgery, 18(3.9%) retroperitoneal tumor resection and 1(0.2%) other surgery. In no PAS group, there were 328 males (70.7%) and 136 females (29.3%) with a median age of 62(24-86) years. No significant differences in baseline data were found between the two groups (all P>0.05). As compared to no PAS group, PAS group had longer mean operative time [(208.0±27.0) minutes vs. (179.0±15.3) minutes, t=4.695, P=0.003] and higher rate of conversion to laparotomy [18.1%(84/464) vs. 11.6%(54/464), χ=7.217, P=0.003]. In the PAS group, conversion to laparotomy was more common due to adhesion reaction [8.8%(41/464) vs. 4.5%(21/464), χ=4.886, P=0.007]. There were no significant differences between the two groups in intraoperative bleeding and transfusion, lymph node dissection, circumferential margin and surgical margin, time to the first diet and postoperative hospital stay(all P>0.05). No significant differences in intraoperative and postoperative morbidity of complication were found between PAS group and no PAS group [3.7%(17/464) vs. 2.8%(13/464), P=0.346; 20.3%(94/464) vs. 18.5%(86/464), P=0.739]. Median follow-up of the whole patients was 32.0(0.5-79.0) months, and there was no significant difference between the two groups [PAS group 31.0(0.5-79.0) months vs. no PAS group 33.0(1.0-75.0) months, P=0.391]. In PAS and no PAS group, the 3-year disease-free survival rate was 68.1%(95%CI: 62.0%-74.2%) and 68.5%(95%CI: 63.0%-74.0%)(P=0.764), and 3-year overall survival rate was 78.5%(95%CI: 72.8%-81.4%) and 80.2%(95%CI:74.3%-86.1%)(P=0.528) respectively, whose differences were not significant.</p><p><b>CONCLUSION</b>Except higher risk of conversion to laparotomy due to adhesion reaction, laparoscopic resection of colorectal cancer is safe and feasible in patients with PAS, and the prognosis is not affected by PAS.</p>

Economic burden of stomach cancer in China during 1996-2015: a systematic review / 中华预防医学杂志

Objective@#To clarify the research status of economic burden of stomach cancer in China from 1996 to 2015.@*Methods@#Based on three electronic literature databases (China Knowledge Resource Integrated Database, Wanfang Database and PubMed), a total of 2 873, 1 244 and 84 articles published during 1996 to 2015 were found, respectively, using keywords of"cancer","neoplasms","malignant tumor","tumor","economic burden","health expenditure","cost","cost of illness", and"China". According to the inclusion and exclusion criteria, 30 literatures were included in the final analysis. Then the basic information and study subjects, indicators and main results of economic burden were abstracted and analyzed. All the expenditure data were discounted to the values in 2013 by using China's percapita consumer price index.@*Results@#Totally, 30 articles were included, covering 14 provinces and of which 16 were published during 2011-2015. One article was based on population-level and the remaining studies were all based on individual-level. The number of individual-level articles that reported direct medical, non-medical and indirectly economic burden was 29, 1 and 2, respectively. The main indicators of direct medical expenditure were expenditure per patient (22), per clinical visit (9) and per diem (11), respectively. The median expenditure per patient was 7 387-28 743 RMB (CNY), with average annual growth rate (AAGR) of 1.7% (1996-2013). The median expenditure per clinical visit was 18 504-41 871 RMB (2003-2013), with AAGR of 5.5%. The median expenditure per diem was 313-1 445 RMB (1996-2012), with AAGR of 3.7%. Difference was found among provinces.@*Conclusions@#The evidence for economic burden of stomach cancer was still limited over the past two decades and mainly focused on individual and regional levels. An increase and differences in provinces were observed in direct medical expenditure. Evaluation on direct non-medical and indirect medical expenditure needs to be addressed.

Virtual reality technology can supplement occupational therapy in improving the upper extremity motor func-tion of children with cerebral palsy / 中华物理医学与康复杂志

Objective To observe the effect of combining virtual reality technology with occupational thera-py in treating children with spastic hemiplegia resulting from cerebral palsy. Methods Thirty-eight spastic and hemiplegic children with cerebral palsy were randomly divided into a treatment group ( n=18) and a control group ( n=20) . Both groups received occupational therapy, while the treatment group was additionally provided with virtual reality-based treatment. The sessions lasted 30 min, 6 times a week for 3 months. Before and after the treatment the upper extremity motor function of both groups was assessed using the fine motor quotients of the Peabody developmen-tal motor scale, the Caroll hand function scale and a activities of daily life scale. Results Before the treatment there was no significant difference between the two groups in terms of any of the measurements. After the 3 months, significant improvement was observed in both groups, but the improvement of the treatment group was significantly greater than that of the control group. Conclusion Virtual reality technology can further improve the motor function of the upper ex-tremities and ability in the activities of daily life beyond that achievable through occupational therapy alone.

Effect of Early Cognitive and Speech Intervention on Developmental Delay / 中国康复理论与实践

Objective To observe the effect of early cognitive and speech intervention on children with developmental delay. Methods 58 inpatient or outpatient children with developmental delay from June, 2014 to June, 2015 were diveded into observation group (n=32) and control group (n=26). The observation group accepted early cognitive and speech therapy and routine rehabilitation training, while the con-trol group accepted the routine rehabilitation only. They were assessed with Gesell Development Schedule before and 3 months after treat-ment. Results The developmental quotient of the gross movement, fine movement, language and peasonal-social improved in both groups af-ter treatment (t>2.90, P2.84, P36.52, P<0.01). Conclusion Early cognitive and speech intervention may improve development of many dimensions in children with developmental delay. The earlier the intervention, the better the outcome.

The characteristics of visual P300 event-related potentials in children with mental retardation and the correlation with intelligent quotient / 中国医师杂志

Objective To explore the characteristics of visual P300 event-related potentials (ERP) in children with mental retardation and evaluate the correlations between visual P300 in event-related potentials and intelligent quotient.Methods Thirty children with mental retardation were selected as the test group who were inpatients or saw a doctor in the Department of Rehabilitation of Hunan Children Hospital.At the same time,thirty normal children were selected as the control group who saw a doctor in the Department of Child Healthcare of Hunan Children Hospital.Two groups had no statistically significant difference in sex and age (P ＞ 0.05) and were comparable.All children were administered with the Wechsler intelligence test in the Department of Child Healthcare and the visual event-related potential test in the Department of Rehabilitation.The results of the visual P300 latency and amplitude were analyzed.Another,the relevance between intelligent quotient (IQ) and P300 latency and amplitude were also compared by statistics.Results Compared to the control group,the visual P300 latency in children with mental retardation (MR) was apparently longer and the amplitude decreased significantly in children with MR,with a statistically significant difference between two groups(P ＜0.05).P300 latency in MR expected negative correlation with intelligent quotient and the amplitude in MR expected no correlation with intelligent quotient.Conclusions P300 latency and amplitude of ERP could objectively reflect cognitive function in children with MR,could be regarded as one of the objective measurement in the evaluation of cognitive function in children with MR.It can be used as an objective electrophysiological index for assisting in the diagnosis of mental retardation of children in clinic.

Colorectal cancer screening: situation and prospect / 中华预防医学杂志

Colorectal cancer (CRC) is the fourth most common cause of cancer death in China and the incidence has been increasing during the decades. It is reported to take decades for adenoma to transform to carcinoma, which is known as the main CRC pre-cancer lesion. It is important to carry out mass screening in the average risk populations to find the pre-cancer lesion and early cancer, which was the key approach to improve CRC survival. Fecal occult blood test and flexible sigmoidoscopy are the two CRC screening methods, which have been shown to reduce CRC mortality. It still needs to be confirmed in random clinical trials that the value of colonoscopy in CRC screening. In China, the most CRC screening experience was drawn from the works in Zhejiang province in 1970s. Consequently, the Chinese CRC treatment and guideline was founded to provide standard for the CRC screening project.

Characteristics of recurrence in patients with gastric cancer after radical gastrectomy and adjuvant chemotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of recurrence in gastric cancer patients after radical gastrectomy and adjuvant chemotherapy.</p><p><b>METHODS</b>The clinicopathological data of 110 gastric cancer patients who developed recurrence or second primary malignancies after radical gastrectomy and adjuvant chemotherapy with FOLFOX4 regimen or docetaxel plus FOLFOX4 regimen were analyzed retrospectively.</p><p><b>RESULTS</b>The median time to recurrence was 13.9 months (range, 1.7 to 63.1 months), and the median overall survival was 27.4 months (range, 6.9 to 90.7 months) in the whole group. The median survival time after recurrence was 10.1 months (range, 0.3 to 73.9 months). 82 (74.5%) patients had recurrence within 2 years after gastrectomy. The modes of surgical procedure and lymph node dissection influenced significantly on the time to recurrence (P<0.05 for both). Among the 110 patients with recurrence, 46 (41.8%) patients had peritoneal metastases, 33 (30.0%) had hematogenous metastases and 32 (29.1%) had locoregional lymph node metastases. Single, double, triple and quatro recurrences were observed at the first time of relapse in 78 (70.9%), 21(19.1%), 9(8.2%) and 2 cases (1.8%), respectively. Patients who developed simultaneous quatro recurrence had the poorest prognosis with a median overall survival of 15.2 months, significantly shorter than that of patients with single recurrence (31.8 months, P=0.003). Patients with peritoneal recurrence died most quickly ( mean 5.6 months), and patients with surgical field recurrence alone survived longest (mean 17.1 months).</p><p><b>CONCLUSIONS</b>Peritoneal, hematogenous and locoregional lymph node metastases are the most frequent recurrences after radical gastrectomy and adjuvant chemotherapy in patients with gastric cancer. Single recurrence occurred in most patients at the first relapse. Combination with other adjuvant treatments should be considered besides adjuvant chemotherapy in gastric cancer patients after radical gastrectomy.</p>

Clinical significance of laparoscopic-assisted radical gastrectomy in advanced gastric cancer / 临床外科杂志

Objective To study the effect of laparoscopicassisted radical gastrectomy in advanced gastric cancer.Methods According to the inclusion criteria,164 patients with advanced gastriccancer who treated in the Cancer Institute and Hospital,Chinese Academy of Medical Sciences betweenJanuary and June of 2009 were enrolled into the study.Based on the operation methods,all cases were divided into the experimental group(laparoscopy group,n =79)and the control group(laparotomy group,n =85).Except for the laparoscopicassisted radical gastrectomy,patients received the same treatment in thethe experimental group and control group.Intraoperative indexes,postoperative pathological results and recovery,complications and 5year survival rate were observed and compared between groups.Results Therecovery time of patient's general condition in the experimental group was shorter than that of the controlgroup(P 0.05).Conclusion Laparoscopicassisted radical gastrectomy is safe and feasible in the treatmentof advanced gastric cancer.This technique could get equal treatment effect as laparotomy and it has obviousadvantage in postoperative recovery.

Evaluation of Botulinum Toxin A for Spastic Dipledia by Surface Electromyography / 中国康复理论与实践

@# Objective To evaluate the effect of Botulinum Toxin A (BTX-A) on spastic diplegia by surface electromyography (sEMG). Methods 50 children with cerebral palsy following spastic diplegia were recruited and injected with BTX-A in triceps surae. They were assessed with the clinical test and the sEMG before and after the treatment. Results After the treatment, the integrated electromyography(iEMG) of triceps surae and foot dorsiflexion angle all decreased. Conclusion sEMG is an objective tool to assess the change of spasticity in children with diplegia after BTX-A injection.

Effects of Electromyographic Biofeedback Electric Stimulation Therapy on Lower Extremities Motor Dysfunction in Spastic Hemiplegic Cerebral Palsy / 中国康复理论与实践

@#Objective To observe the effects of electromyographic biofeedback electric stimulation therapy on lower extremities motordysfunction in children with spastic hemiplegic cerebral palsy (CP). Methods According to the consent of the custodians to the new therapy,60 children with spastic hemiplegic CP were divided into treatment group and control group with 30 cases in each group. All children weretreated with motor training, physical therapy and wore the ankle-foot orthosis (AFO). The treatment group was received electromyographicbiofeedback electric stimulation therapy on their lower extremity additionally. Composite Spasticity Scale (CSS) of the hemiplegic lower extremities,the ankle angle of passive dorsiflexion motion, D and E domains of Gross Motor Function Measure (GMFM-88) were performedto comparatively evaluate the effects before and 12 weeks after treatment. Results The outcomes were improved compared with the ones ofpre-treatment (P<0.05), and improved more in the treatment group (P<0.05). Conclusion The electromyographic biofeedback stimulationtherapy in combination with rehabilitation functional training in the treatment for children with spastic hemiplegic CP is more effective onspasticity of the lower extremity, increasing the range of ankle motion, improving gross motor function of lower extremities.

Correlation between Gesell Developmental Scales and Peabody Developmental Motor Scales-2 in Children with Zentrale Koordination Storung / 中国康复理论与实践

@# ObjectiveTo investigate the correlation between the Gesell Developmental Scale and the Peabody Developmental Motor Scale-2(PDMS-2) in children with zentrale koordination storung(ZKS).Methods657 children with ZKS, aged 3 to 8 months, administered both the Gesell Developmental Scales and the PDMS-2. The correlation coefficients of the Gesell gross motor developmental age and the PDMS-2 gross motor subscale age-equivalent scores, the Gesell fine motor developmental age and the PDMS-2 fine motor subscale age-equivalent scores, the Gesell gross motor Developmental Quotient(G-GMDQ) and the PDMS-2 Gross Motor Quotient (P-GMDQ), the Gesell fine motor DQ(G-FMDQ) and the PDMS-2 Fine Motor Quotient(P-FMDQ) was compared by the Spearman rank correlation coefficient.ResultsThe correlation coefficients of the Gesell motor developmental age and the PDMS-2 motor subscale age-equivalent scores were 0.755 to 0.845(P<0.01). The correlation coefficients of G-GMDQ and P-GMDQ, G-FMDQ and P-FMDQ were 0.645 and 0.677(P<0.01) respectively.ConclusionThe concurrent validity were high correlation between the PDMS-2 gross motor subscale age-equivalent scores and the Gesell gross motor developmental age, the PDMS-2 fine motor subscale age-equivalent scores and the Gesell fine motor developmental age, and P-FMDQ and the G-FMDQ. The concurrent validity was moderate correlation between P-GMDQ and G-GMDQ.

Effects of Botulinum Toxin Type A Injection Combined with Functional Training on Tiptoe Deformation and Gross Motor Function in Children with Spastic Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo study the effects of botulinum toxin type A (BTX-A) injection combined with functional training on the tiptoe deformation and gross motor function in children with spastic cerebral palsy (SCP). Methods60 SCP children with tiptoe deformation whose family consented to inject BTX-A were as treatment group and treated with BTX-A combined with function training, while other 46 SCP children as control group were only treated with functional training. They were assessed with Composite Spasticity Scale (CSS), the angle of ankle passive dorsiflexion motion and D and E domains of Gross Motor Function Measure (GMFM) before and 1 week, and 3 months after treatment. ResultsThe effect of BTX-A began from 24 to 72 h after injection, reached the peak from 1 to 2 weeks, maintained beyond 3 months with few side effects. There were significant differences between 2 groups in the outcome of CSS,the angle and the standing and walking value (GMFM) 1 week and 3 months after treatment (P<0.01). ConclusionBTX-A combined with functional training is more effective on reducing spasticity of the lower extremity, correcting the tiptoe deformation, increasing the range of ankle motion, improving gross motor function.

Effects of Botulinum Toxin Type A on Upper Extremities Function of Children with Spastic Cerebral Palsy / 中国康复理论与实践

@#ObjectiveTo explore the effects of Botulinum toxin type A （BTX-A） on upper extremities function of children with spastic cerebral palsy. Methods27 children with spastic cerebral palsy who were treated with comprehensive rehabilitation training and BTX-A were arranged as treatment group, and other 30 children who were treated with comprehensive rehabilitation training only as control group. They were assessed with upper extremities functional test (UEFT) before and after treatment. ResultsAfter 3 months of treatment, the scores of UEFT improved more in the treatment group than in the control group (P<0.01). ConclusionBTX-A can improve upper extremities function of the children with spastic cerebral palsy.

The diagnosis and treatment of duodenal polys and research reviews:14 cases / 中国综合临床

Objective To summarize the experience of diagnosis and treatment of the duodenal polys.Methods 14 patients of duodenal polys admitted between 1987 and 2006 were analyzed retrospectively.Results Clinical manifestations were melena,epigastric discomfort, abdominal pain,weight loss and abdominal distention.The ratio of correct diagnosis were 60% with duodenal endoscopy,56% with upper gastrointestinal radiography and 44% with CT.Most duodenal adenomas located at the second portion of the duodenum.8 duodenal adenomas turned into carcinoma and 2 cases recured in a year after operation.Conclusion Duodenal endoscopy and upper gastrointestinal radiography were effective for diagnosis of duodenal polys.Endoscopic ultrasound(EUS)helps to improve the diagnosis of the leions in submucosa.It should pay attention to the treatment of doudenal adenomas actively.The surgery remained the mainstay of the treatment.It needed attention for the screening and treatment of the duodenal adenomas.