Application of improved 3D digital guide plate-assisted guided puncture in microballoon compression for primary trigeminal neuralgia / 口腔疾病防治

Objective @#To investigate the clinical efficacy and application value of an improved 3D-printed guide plate for the treatment of primary trigeminal neuralgia (PTN) by percutaneous microballoon compression (PMC). @*Methods @# This prospective study included 42 patients with primary trigeminal neuralgia treated at the Department of Stomatology, Xuzhou Central Hospital, from September 2019 to January 2022. The group was divided by the random number table method into the experimental group (adopting 3D printing technology to make guide plates to guide the puncture, 22 cases) and the control group (adopting the traditional Hartel anterior approach to position the puncture, 20 cases). The intraoperative success rate of the first puncture, puncture time, operative time, radiation exposure of patients and postoperative complications were compared between the two groups. Postoperative Barrow Neurological Institute Scale (BNI) scores, facial numbness, diminished corneal reflexes and chewing weakness were recorded. The t-test, rank-sum test and chi-square test were used for statistical analysis, with P<0.05 indicating a statistically significant difference. @*Results @#The experimental group was significantly better than the control group in terms of the success rate of the first puncture (χ2 = 21.51, P<0.001), puncture time (Z = -5.51, P<0.001), operative time (t = 9.37, P<0.001), and the number of C-arm scans (Z = -4.59, P<0.001). Postoperative BNI scores of the experimental group included 21 cases of grade Ⅰ (91.5%) and 1 case of grade Ⅱ, while the control group included 17 cases of grade Ⅰ (85.0%), 2 cases of grade Ⅱ (10.0%) and 1 case of grade Ⅲ (5.0%), with no statistical significance (P>0.05). In the experimental group, 16 patients had postoperative masseter weakness, 1 had keratitis and 10 had perilabial herpes, while in the control group, 18 patients had postoperative masseter weakness, 2 had keratitis, 11 had perilabial herpes and 1 had monocular blindness. There was no significant difference in postoperative complications between the two groups (P>0.05). At 12 months of follow-up, there was no recurrence in either the experimental or control group. @* Conclusions @#3D digital guide plate-guided percutaneous microballoon compression for primary trigeminal neuralgia can improve the accuracy and safety of puncture to a certain extent, obviously shorten the operation time, reduce radiation exposure of the patients, improve the success rate of the operation, meaning it has a high clinical application value.

Functional gastrointestinal reconstruction strategies after laparoscopic proximal gastrectomy / 中华消化外科杂志

The incidence of adenocarcinoma of esophagogastric junction is gradually increa-sing. The metastasis of the distal lymph node of upper gastric cancer with tumor diameter <4 cm is rare, and proximal gastrectomy can meet the requirements of radical treatment. Reflux esophagitis, food stasis, anastomotic stenosis, and poor nutrient absorption are important factors affecting the quality of life of patients undergoing proximal gastrectomy. With the continuous promotion of laparoscopic radical gastrectomy, laparoscopic proximal gastrectomy with lymph node dissection has been standardized. However, the method of digestive tract reconstruction has not yet reached standardization consensus, and anti-reflux has become a hot spot in clinical attention in recent years. Through interpositioned jejunum reconstruction to achieve anti-reflux effect, or retaining or rebuilding the anti-flow structure of esophageal residual gastric anastomosis include a variety of additional anti-reflux surgery, which have their own different advantages and disadvan-tages. The authors introduce in detail a variety of mainstream anti-reflux surgery, and its modified program, with the aim of providing reference for colleagues and maximizing the benefits of patients.

Prognostic value of a predictive model comprising preoperative inflammatory response and nutritional indexes in patients with gastric cancer / 中华胃肠外科杂志

Objective: To investigate the prognostic value of preoperative inflammatory and nutritional condition detection in the postoperative survival, and establish a prognostic model for predicting the survival of patients with gastric cancer. Methods: The clinicopathological data of 1123 patients with gastric cancer who had undergone radical gastrectomy in Tianjin Medical University Cancer Institute & Hospital from January 2005 to December 2014 were retrospectively analyzed. Patients with history of other malignancy, with history of gastrectomy, who had received preoperative treatment, who died during the initial hospital stay or first postoperative month, and missing clinical and pathological information were excluded. Cox univariate and multivariate analyses were used to identify independent clinicopathological factors associated with the survival of these gastric cancer patients. Cox univariate analysis was used to identify preoperative inflammatory and nutritional indexes related to the survival of patients with gastric cancer after radical gastrectomy. Moreover, the Cox proportional regression model for multivariate survival analysis (forward stepwise regression method based on maximum likelihood estimation) was used. The independent clinicopathological factors that affect survival were incorporated into the following three new prognostic models: (1) an inflammatory model: significant preoperative inflammatory indexes identified through clinical and univariate analysis; (2) a nutritional model: significant preoperative nutritional indexes identified through clinical and univariate analysis; and (3) combined inflammatory/nutritional model: significant preoperative inflammatory and nutritional indexes identified through clinical and univariate analysis. A model that comprised only pT and pN stages in tumor TNM staging was used as a control model. The integrated area under the receiver operating characteristic curve (iAUC) and C-index were used to evaluate the discrimination of the model. Model fitting was evaluated by Akaike information criterion analysis. Calibration curves were used to assess agreement between the predicted probabilities and actual probabilities at 3-year or 5-year overall survival (OS). Results: The study cohort comprised 1 123 patients with gastric cancer. The mean age was 58.9±11.6 years, and 783 were males. According to univariate analysis, age, surgical procedure, extent of lymph node dissection, tumor location, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, and nerve invasion were associated with 5-year OS after radical gastrectomy for gastric cancer (all P<0.050). Multivariate analysis further identified age (HR: 1.18, 95%CI: 1.03-1.36, P=0.019), maximum tumor size (HR: 1.19, 95%CI: 1.03-1.38, P=0.022), number of examined lymph nodes (HR: 0.79, 95%CI: 0.68-0.92, P=0.003), pT stage (HR: 1.40, 95%CI: 1.26-1.55, P<0.001) and pN stage (HR: 1.28, 95%CI: 1.21-1.35, P<0.001) as independent prognostic factors for OS of gastric cancer patients. Additionally, according to univariate survival analysis, the preoperative inflammatory markers of neutrophil count, percentage of neutrophils, neutrophil/lymphocyte ratio, platelet/neutrophil ratio and preoperative nutritional indicators of serum albumin and body mass index were potential prognostic factors for gastric cancer (all P<0.05). On the basis of the above results, three models for prediction of prognosis were constructed. Variables included in the three models are as follows. (1) Inflammatory model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, percentage of neutrophils, and neutrophil-lymphocyte ratio; (2) nutritional model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, and serum albumin; and (3) combined inflammatory/nutritional model: age, maximum tumor size, number of examined lymph nodes, pT stage, pN stage, percentage of neutrophils, neutrophil-lymphocyte ratio, and serum albumin. We found that the predictive accuracy of the combined inflammatory/nutritional model, which incorporates both inflammatory indicators and nutrition indicators (iAUC: 0.676, 95% CI: 0.650-0.719, C-index: 0.698),was superior to that of the inflammation model (iAUC: 0.662, 95% CI: 0.673-0.706;C-index: 0.675), nutritional model (iAUC: 0.666, 95% CI: 0.642-0.698, C-index: 0.672), and TNM staging control model (iAUC: 0.676, 95% CI: 0.650-0.719, C-index: 0.658). Furthermore, the combined inflammatory/nutritional model had better fitting performance (AIC: 10 762) than the inflammatory model (AIC: 10 834), nutritional model (AIC: 10 810), and TNM staging control model (AIC: 10 974). Conclusions: Preoperative percentage of neutrophils, NLR, and BMI have predictive value for the prognosis of gastric cancer patients. The inflammatory / nutritional model can be used to predict the survival and prognosis of gastric cancer patients on an individualized basis.

Differences in clinicopathological features, gene mutations, and prognosis between primary gastric and intestinal gastrointestinal stromal tumors in 1061 patients / 中华胃肠外科杂志

Objective: To analyze the clinicopathological features and gene mutations of primary gastrointestinal stromal tumors (GISTs) of the stomach and intestine and the prognosis of intermediate- and high-risk GISTs. Methods: This was a retrospective cohort study. Data of patients with GISTs admitted to Tianjin Medical University Cancer Institute and Hospital from January 2011 to December 2019 were collected retrospectively. Patients with primary gastric or intestinal disease who had undergone endoscopic or surgical resection of the primary lesion and were confirmed pathologically as GIST were included. Patients treated with targeted therapy preoperatively were excluded. The above criteria were met by 1061 patients with primary GISTs, 794 of whom had gastric GISTs and 267 intestinal GISTs. Genetic testing had been performed in 360 of these patients since implementation of Sanger sequencing in our hospital in October 2014. Gene mutations in KIT exons 9, 11, 13, and 17 and PDGFRA exons 12 and 18 were detected by Sanger sequencing. The factors investigated in this study included: (1) clinicopathological data, such as sex, age, primary tumor location, maximum tumor diameter, histological type, mitotic index (/5 mm2), and risk classification; (2) gene mutation; (3) follow-up, survival, and postoperative treatment; and (4) prognostic factors of progression-free survival (PFS) and overall survival (OS) for intermediate- and high-risk GIST. Results: (1) Clinicopathological features: The median ages of patients with primary gastric and intestinal GIST were 61 (8-85) years and 60 (26-80) years, respectively; The median maximum tumor diameters were 4.0 (0.3-32.0) cm and 6.0 (0.3-35.0) cm, respectively; The median mitotic indexes were 3 (0-113)/5 mm² and 3 (0-50)/5 mm², respectively; The median Ki-67 proliferation indexes were 5% (1%-80%) and 5% (1%-50%), respectively. The rates of positivity for CD117, DOG-1, and CD34 were 99.7% (792/794), 99.9% (731/732), 95.6% (753/788), and 100.0% (267/267), 100.0% (238/238), 61.5% (163/265), respectively. There were higher proportions of male patients (χ²=6.390, P=0.011), tumors of maximum diameter > 5.0 cm (χ²=33.593, P<0.001), high-risk (χ²=94.957, P<0.001), and CD34-negativity (χ²=203.138, P<0.001) among patients with intestinal GISTs than among those with gastric GISTs. (2) Gene mutations: Gene mutations were investigated in 286/360 patients (79.4%) with primary gastric GISTs and 74/360 (20.6%) with primary intestinal GISTs. Among the 286 patients with gastric primary GISTs, 79.4% (227/286), 8.4% (24/286), and 12.2% (35/286), had KIT mutations, PDGFRA mutations, and wild-type, respectively. Among the 74 patients with primary intestinal GISTs, 85.1% (63/74) had KIT mutations and 14.9% (11/74) were wild-type. The PDGFRA mutation rate was lower in patients with intestinal GISTs than in those with gastric GISTs[ 0% vs. 8.4%(24/286), χ²=6.770, P=0.034], whereas KIT exon 9 mutations occurred more often in those with intestinal GISTs [22.2% (14/63) vs. 1.8% (4/227), P<0.001]. There were no significant differences between gastric and intestinal GISTs in the rates of KIT exon 11 mutation type and KIT exon 11 deletion mutation type (both P>0.05). (3) Follow-up, survival, and postoperative treatment: After excluding 228 patients with synchronous and metachronous other malignant tumors, the remaining 833 patients were followed up for 6-124 (median 53) months with a follow-up rate of 88.6% (738/833). None of the patients with very low or low-risk gastric (n=239) or intestinal GISTs (n=56) had received targeted therapy postoperatively. Among 179 patients with moderate-risk GISTs, postoperative targeted therapy had been administered to 88/155 with gastric and 11/24 with intestinal GISTs. Among 264 patients with high-risk GISTs, postoperative targeted therapy had been administered to 106/153 with gastric and 62/111 with intestinal GISTs. The 3-, 5-, and 10-year PFS of patients with gastric or intestinal GISTs were 96.5%, 93.8%, and 87.6% and 85.7%, 80.1% and 63.3%, respectively (P<0.001). The 3-, 5-, and 10-year OS were 99.2%, 98.8%, 97.5% and 94.8%, 92.1%, 85.0%, respectively (P<0.001). (4) Analysis of predictors of intermediate- and high-risk GISTs: The 5-year PFS of patients with gastric and intestinal GISTs were 89.5% and 73.2%, respectively (P<0.001); The 5-year OS were 97.9% and 89.3%, respectively (P<0.001). Multivariate analysis showed that high risk (HR=2.918, 95%CI: 1.076-7.911, P=0.035) and Ki-67 proliferation index > 5% (HR=2.778, 95%CI: 1.389-5.558, P=0.004) were independent risk factors for PFS in patients with intermediate- and high-risk GISTs (both P<0.05). Intestinal GISTs (HR=3.485, 95%CI: 1.407-8.634, P=0.007) and high risk (HR=3.753,95%CI:1.079-13.056, P=0.038) were independent risk factors for OS in patients with intermediate- and high-risk GISTs (both P<0.05). Postoperative targeted therapy was independent protective factor for PFS and OS (HR=0.103, 95%CI: 0.049-0.213, P<0.001; HR=0.210, 95%CI:0.078-0.564,P=0.002). Conclusions: Primary intestinal GIST behaves more aggressively than gastric GISTs and more frequently progress after surgery. Moreover, CD34 negativity and KIT exon 9 mutations occur more frequently in patients with intestinal GISTs than in those with gastric GISTs.

Impacts of table tennis on the health of young students / Impactos do tênis de mesa sobre a saúde de jovens estudantes / Impactos del tenis de mesa en la salud de jóvenes estudiantes

ABSTRACT Introduction By improving the material level of life, the amount of exercise of adolescents is decreasing, leading the muscular strength and cardiorespiratory resistance to also decrease instead of increase. Therefore, it is urgent to present effective training methods in physical education teaching to benefit adolescents' quality of life. Objective Study the effect of table tennis training on musculature and cardiorespiratory endurance in young students. Methods 60 students from grade 7 of a high school were randomly divided into experimental and control groups. The experiment lasted for 9 weeks. In this paper, intra-group comparisons and inter-group comparisons were used. Before the experiment and after 9 weeks of training, students had their biophysical indicators collected; these data were analyzed and statistically compared. Results Existing physical education training can overall improve students' physical muscular and cardiopulmonary endurance. The results show that the current training is effective, but inferior to that experienced with table tennis, and should be adjusted. Conclusion In teaching high school youth, physical education teachers are advised to promote table tennis to promote the young student's health. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Ao melhorar o nível de vida material, a quantidade de exercício dos adolescentes está diminuindo, levando a força muscular e a resistência cardiorrespiratória a também diminuem ao invés de aumentar. Portanto, é urgente apresentar métodos de treinamento eficazes no ensino da educação física, visando beneficiar o nível de qualidade de vida dos adolescentes. Objetivo Estudar o efeito do treinamento de tênis de mesa sobre a musculatura e a resistência cardiorrespiratória em jovens estudantes. Métodos 60 alunos da série 7 de uma escola de ensino médio foram aleatoriamente divididos em grupo experimental e controle. O experimento durou 9 semanas. Neste trabalho, foram usadas a comparação intragrupo e a comparação intergrupo. Antes do experimento e após 9 semanas de treinamento, os alunos tiveram seus indicadores biofísicos coletados, esses dados foram analisados e comparados estatisticamente. Resultados O treinamento de educação física existentes podem melhorar globalmente a resistência muscular física e cardiopulmonar dos alunos. Os resultados mostram que o treinamento atual é eficaz, porém inferior ao experimentado com o tênis de mesa, devendo ser ajustados. Conclusão Na atual situação do ensino para jovens do ensino médio, é aconselhado aos professores de educação física promoverem o tênis de mesa como uma medida auxiliar na promoção integral da saúde do jovem estudante. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Al mejorar el nivel de vida material, la cantidad de ejercicio de los adolescentes está disminuyendo, lo que hace que la fuerza muscular y la resistencia cardiorrespiratoria también disminuyan en lugar de aumentar. Por lo tanto, es urgente presentar métodos de formación eficaces en la enseñanza de la educación física, con el objetivo de beneficiar el nivel de calidad de vida de los adolescentes. Objetivo Estudiar el efecto del entrenamiento de tenis de mesa sobre la musculatura y la resistencia cardiorrespiratoria en jóvenes estudiantes. Métodos 60 estudiantes de 7º curso de un instituto se dividieron aleatoriamente en grupo experimental y grupo de control. El experimento duró 9 semanas. En este trabajo se utilizó la comparación intragrupo y la comparación intergrupo. Antes del experimento y después de 9 semanas de entrenamiento, se recogieron los indicadores biofísicos de los estudiantes, se analizaron estos datos y se compararon estadísticamente. Resultados El entrenamiento de educación física existente puede mejorar la resistencia física muscular y cardiopulmonar general de los estudiantes. Los resultados demuestran que el entrenamiento actual es eficaz, pero inferior al experimentado con el tenis de mesa, y debería ajustarse. Conclusión En la situación actual de la enseñanza para jóvenes de secundaria, se aconseja que los profesores de educación física promuevan el tenis de mesa como medida auxiliar en la promoción integral de la salud del joven estudiante. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Influence of sports injuries and resistance training on skiers' bone mass / Influência de lesões esportivas e treinamento de resistência na massa óssea de esquiadores / Influencia de las lesiones deportivas y del entrenamiento de resistencia en la masa ósea de los esquiadores

ABSTRACT Introduction: With the preparation and development of the Winter Olympic Games, there has been an increase in the popularity of skiing. Driven by this demand, the professional development of coaches requires updates in the analysis of skiers' sports injuries, elaboration of corresponding prevention and treatment strategies, and resistance training to promote the development of athletes' physical quality, such as bone mass and mineral density. Objective: Study the sports injuries of skiers and explore needs and ways of applying resistance training in skiing. Methods: The questionnaire survey was used to explore the main types of injuries and their influencing factors. Then, 20 volunteers were selected for the resistance training experiment; each group of 10 people included five men and five women. The control group maintained a normal daily life, while resistance training was added to the experimental group three times a week, based on the control group. Results: The research results showed that the current proportion of skiing injuries was relatively high, mainly in mild injuries. After nine weeks in the experimental resistance training group, both men and women had positive bone mass development. Conclusion: Resistance training can improve physical quality and reduce the occurrence of sports injuries, demonstrating the benefits of its implementation in endurance training for skiers. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Com a preparação e desenvolvimento dos Jogos Olímpicos de Inverno, houve um aumento da popularidade do esqui. Impulsionados por essa demanda, o desenvolvimento profissional dos treinadores requer atualizações nas análises de lesões esportivas dos esquiadores, elaboração de estratégias de prevenção e tratamento correspondentes, além de treinamentos de resistência de modo a promover o desenvolvimento da qualidade física dos atletas, como a massa óssea e sua densidade mineral. Objetivo: Estudar as lesões esportivas dos esquiadores e explorar necessidades e modos de aplicação do treino de resistência no esqui. Métodos: O método de pesquisa por questionário foi utilizado para explorar os principais tipos de lesões e seus fatores influenciadores. Em seguida, 20 voluntários foram selecionados para o experimento de treinamento de resistência, cada grupo de 10 pessoas incluiu 5 homens e 5 mulheres. O grupo controle manteve uma vida diária normal, enquanto ao grupo experimental foi adicionado um treinamento de resistência, três vezes por semana, com base no grupo controle. Resultados: Os resultados da pesquisa mostraram que a proporção atual de lesões por esqui foi relativamente alta, principalmente em lesões leves. Após 9 semanas no grupo experimental de treinamento de resistência, tanto homens quanto mulheres tiveram desenvolvimento positivo de massa óssea. Conclusão: O treinamento de resistência pode não só melhorar a qualidade física, mas também reduzir a ocorrência de lesões esportivas, demonstrando os benefícios de sua implementação no treinamento de resistência dos esquiadores. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Con la preparación y el desarrollo de los Juegos Olímpicos de Invierno, ha aumentado la popularidad del esquí. Impulsado por esta demanda, el desarrollo profesional de los entrenadores requiere actualizaciones en el análisis de las lesiones deportivas de los esquiadores, la elaboración de las correspondientes estrategias de prevención y tratamiento, así como el entrenamiento de la resistencia para promover el desarrollo de la calidad física de los atletas, como la masa ósea y la densidad mineral. Objetivo: Estudiar las lesiones deportivas de los esquiadores y explorar las necesidades y formas de aplicar el entrenamiento de resistencia en el esquí. Métodos: Se utilizó el método de encuesta por cuestionario para explorar los principales tipos de lesiones y sus factores de influencia. A continuación, se seleccionaron 20 voluntarios para el experimento de entrenamiento de resistencia, cada grupo de 10 personas incluía 5 hombres y 5 mujeres. El grupo de control mantuvo una vida diaria normal, mientras que al grupo experimental se le añadió un entrenamiento de resistencia, tres veces por semana, basado en el grupo de control. Resultados: Los resultados de la investigación mostraron que la proporción actual de lesiones de esquí era relativamente alta, principalmente en las lesiones leves. Después de 9 semanas en el grupo experimental de entrenamiento de resistencia, tanto los hombres como las mujeres tuvieron un desarrollo positivo de la masa ósea. Conclusión: El entrenamiento de resistencia no sólo puede mejorar la calidad física, sino también reducir la aparición de lesiones deportivas, lo que demuestra los beneficios de su aplicación en el entrenamiento de resistencia de los esquiadores. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Extent of lymphadenectomy for local advanced gastric cancer in the era of perioperative treatment and minimally invasive surgery / 中华胃肠外科杂志

The standard lymphadenectomy (D2) is the most important quality control index for the surgical treatment of locally advanced gastric cancer (LAGC). It is debatable whether there is a survival benefit of extended lymphadenectomy beyond D2 dissection. Para-aortic lymph nodes are not included in the range of D2 lymph node dissection. However, the patients with para-aortic node metastasis can get better survival after neoadjuvant chemotherapy and D2+ surgery. Lymph nodes along the superior mesenteric vein (No.14v) are considered as regional nodes, and the prognosis of patients with No.14v metastasis treated with D2+ lymph node dissection is significantly better than that of stage Ⅳ patients undergoing only D2 dissection. No.14v was not included in the D2 lymph node dissection paradigm. In case with nodal metastases in No.6 group, D2+ dissection is recommended. Lymph nodes at the splenic hilum (No.10) are not included in the range of D2 dissection, when the tumor infiltrates the greater curvature of the stomach, D2+ splenectomy or No.10 nodal dissection should be performed. Lymph nodes on the posterior surface of pancreatic head (No.13) do not belong to the D2 range, but the rate of metastasis is significantly higher when distal gastric cancer invades the duodenum, D2+ lymphadenectomy is recommended. Lymph node dissection in the posterior group of the common hepatic artery (No.8p) can improve the patient's long-term survival, but there is no support from of evidence-based medicine. In the era of perioperative treatment and minimally invasive surgery in China, open or laparoscopic D2 lymphadenectomy is recommended for cT3-4N1M0 patients and SOX neoadjuvant chemotherapy plus D2 surgery plus SOX adjuvant chemotherapy should be carried out for patients with cT3-4N2-4M0. Depending on the patient's condition and the experience of the surgical team, open or laparoscopic surgery can be performed.

Surgical strategies for adenocarcinoma of esophagogastric junction under the era of mini-invasive surgery / 中华消化外科杂志

With the continuous update and improvement of minimally invasive techni-ques, laparoscopic and robotic surgeries have increased significantly for the surgical treatment of adenocarcinoma of esophagogastric junction (AEG). Due to the anatomical particularity and biolo-gical characteristics of Siewert type Ⅱ AEG, surgical approach, the range of resection, lymph node dissection and digestive tract reconstruction cannot be unified at present, which is also the contro-versy between gastrointestinal surgery and thoracic surgery. Laparoscopic minimally invasive techni-que may be more conducive to lower mediastinal lymph node dissection. Laparoscopic surgery of AEG after neoadjuvant chemotherapy is safe and feasible. Robotic surgery may be the direction of minimally invasive surgery in the future. The authors mainly investigate strategies of minimally invasive surgery for the surgical treatment of AEG, and look forward to more clinical trials on Siewert type Ⅱ AEG surgery to guide surgical treatment.

Children's pneumonia diagnosis system based on Mach-Zehnder optical fiber sensing technology / 国际生物医学工程杂志

Objective:To explore a fast and accurate method to diagnose children's pneumonia according to respiratory signals, so as to avoid the cancer induction caused by traditional X-ray examination.Methods:A Mach Zehnder optical fiber sensor was used to build a respiratory signals(RSPs) detection system, and the RSPs of the monitored children were extracted according to the vibration signal generated by the children's lung rales. Preprocessing methods such as the discrete cosine transform(DCT) were used to compress and denoise the RSPs. Multi-feature extraction of RSPs was conducted through signal processing methods such as the Hilbert transform and autoregressive (AR) model spectrum estimation. A support vector machine (SVM) classification model was constructed to classify the collected RSPs.Results:The accuracy rate of the proposed RSP classification of children with or without pneumonia was 94.41%, which was higher than the previous methods.Conclusions:The children's pneumonia diagnosis system based on an optical fiber sensor has a higher detection accuracy, and is expected to be widely used in clinical practice.

Clinical efficacy of radical proximal gastrectomy with esophagogastrostomy and double-tract anastomosis for upper gastric cancer / 中华消化外科杂志

Objective:To investigate the clinical efficacy of radical proximal gastrectomy with esophagogastrostomy and double-tract anastomosis for upper gastric cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 172 patients who underwent radical proximal gastrectomy for upper gastric cancer in Tianjin Medical University Cancer Institute and Hospital from January 2018 to December 2020 were collected. There were 147 males and 25 females, aged from 25 to 81 years, with a median age of 62 years. All the 172 patients underwent digestive reconstruction. Of the 172 patients, 83 cases undergoing esophagogastrostomy were allocated into esophagogastrostomy group, 89 cases undergoing double-tract anastomosis were allocated into double-tract anastomosis group. Patients were performed radical proximal gastrectomy combined with D 1+ lymph node dissection by attending surgeons from department of gastric cancer. The operator decided to adopt esophagogastrostomy or double-tract anastomosis for digestive reconstruction. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination, telephone interview, and online APP was conducted at postoperative 1 month, once three months within postoperative 2 years, and once six months within postoperative 2-5 years. The questionnaires of reflux esophagitis, gastroscopy and upper gastrointestinal angio-graphy were conducted to evaluate gastroesophageal reflux and anastomotic stenosis up to February 1, 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Surgical situations: cases with open, laparoscopic or Da Vinci robotic surgery (surgical method), the number of metastatic lymph node, duration of postoperative hospital stay were 74, 9, 0, 2(range, 0-15), (12±4)days for the esophagogastrostomy group, versus 65, 15, 9, 3(range, 0-28), (11±3)days for the double-tract anastomosis group, respectively, showing significant differences in the above indicators between the two groups ( χ2=10.887, Z=-1.058, t=3.284, P<0.05). (2) Follow-up: 172 patients were followed up for 2-38 months, with a median follow-up time of 13 months. Cases with gastroesophageal reflux and anastomotic stenosis were 58 and 10 for the esophagogastrostomy group, versus 14 and 1 for the double-tract anastomosis group, respectively, showing significant differences in the above indicators between the two groups ( χ2=51.743, 7.219, P<0.05). Conclusions:For upper gastric cancer patients undergoing proximal radical gastrectomy, double-tract anastomosis is more suitable for Siewert type Ⅱ adenocarcinoma of esophagogastric junction in large curvature or lower located tumor. Compared with esophago-gastrostomy, double-tract anastomosis has lower incidence of postoperative gastroesophageal reflux and anastomotic stenosis, without increasing complications.

Current status of digestive tract reconstruction after proximal gastrectomy / 中华消化外科杂志

The incidence of gastric cancer in the upper third of the stomach, including early gastric cancer, is increasing in China, South Korea and Japan. Function-preserving surgery for early gastric cancer is mainly aimed at minimizing postoperative complications and improving postoperative quality of life. Proximal gastrectomy can resect the tumor while preserve part of the stomach tissue which is beneficial to improve the postoperative nutritional status and the postoperative quality of life. However, acid reflux, reflux and the subsequent reflux esophagitis after proximal gastrectomy due to the loss of the esophageal sphincter and His angle would affect postoperative quality of life. Clinical surgeons choose different methods of digestive tract reconstruction to improve the effect of anti-esophagogastric reflux. But there are many kinds of digestive tract reconstruction methods, which are controversial. The authors comprehensively analyze the related research progress at home and abroad, systematically elaborate the current status of digestive tract reconstruction after proximal gastrectomy, and discuss the advantages and disadvantages of various digestive tract reconstruction methods.

Association of status of mismatch repair protein expression and EB virus infection with clinicopathological parameters in 886 gastric adenocarcinoma patients / 中华胃肠外科杂志

Objective: To analyze the expression of mismatch repair (MMR) protein and the EB virus infection in gastric adenocarcinoma, and to examine the association of MMR expression and EB virus infection with clinicopathological parameters. Methods: A case-control study was performed. Clinicopathological data of patients who was pathologically diagnosed as gastric adenocarcinoma, received radical gastrectomy and had complete clinicopathological data from August 2017 to April 2020 in Tianjin Medical University Cancer Institute and Hospital were retrospectively collected and analyzed. The immunohistochemistry (IHC) of MMR proteins and in situ hybridization (ISH) of Epstein-Barr virus encoded RNA (EBER) were reviewed. The associations of MMR and EBER results with clinicopathological parameters were analyzed. The main observations of the study were MMR and EBER expression, and association of MMR and EBER results with clinicopathological parameters. Results: Eight hundred and eighty-six patients were enrolled, including 98 patients who received preoperative neoadjuvant chemoradiotherapy. Of 886 patients, 613 (69.2%) were males and the median age was 60 (22-83) years; 831 (93.8%) were mismatch repair proficiency (pMMR), and 55 (6.2%) were mismatch repair deficiency (dMMR). In dMMR group, 47 cases (85.5%) had the deficiency of both MLH1 and PMS2, 1 case (1.8%) had the deficiency of both MSH2 and MSH6, 4 cases (7.3%) had the deficiency only in PMS2, 2 cases (3.6%) had the deficiency only in MSH6, and 1 case (1.8%) had the deficiency only in MSH2. The deficiency rates of PMS2, MLH1, MSH6 and MSH2 were 5.8% (51/886), 5.3% (47/886), 0.3% (3/886) and 0.2% (2/886), respectively. Among the 871 cases with EBER results, 4.9% (43/871) were positive EBER. Univariate analysis showed that dMMR was more frequently detected in female patients (χ(2)=10.962, P=0.001), cancer locating in the antrum (χ(2)=9.336,P=0.020), Lauren intestinal type (χ(2)=9.718, P=0.018), stage T3 (χ(2)=25.866, P<0.001) and TNM stage II (χ(2)=15.470, P=0.002). The ratio of dMMR was not significantly associated with age, tumor differentiation, histological type, lymph node metastasis, distant metastasis or Her-2 immunohistochemical score (all P>0.05). Compared with negative EBER, positive EBER was more frequent in male patients (χ(2)=9.701, P=0.002), cancer locating in gastric fundus and corpus (χ(2)=17.964, P<0.001), gastric cancer with lymphoid stroma (χ(2)=744.073, P<0.001) and poorly differentiated cancer (χ(2)=13.739, P=0.010). Positive EBER was not significantly associated with age, depth of invasion, lymph node metastasis, distant metastasis, TNM stage or Her-2 immunohistochemical score (all P>0.05). In addition, all dMMR cases were EBER negative, and all cases of positive EBER were pMMR. Conclusions: The positive EB virus status is mutually exclusive with dMMR, indicating that different molecular subtypes of gastric adenocarcinoma are involved in different molecular pathways in tumorigenesis and progression. The overlapping of dMMR or positive EBER status and positive Her-2 expression is found in some cases of gastric adenocarcinoma. Patients with gastric adenocarcinoma after radical surgery should be tested for MMR status if they are female, the tumor locates in gastric antrum, the TNM staging is stage II or T3, or if the Lauren classification is intestinal type. And if patients are male, the tumor locates in the gastric fundus and corpus, the cancer is lymphoid stroma, or poor differentiated, the expression of EBER should be detected. Results of our study may provide evidence for further decision-making of clinical treatment.

A multi-center retrospective study of perioperative chemotherapy for gastric cancer based on real-world data / 中华胃肠外科杂志

Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.

Progress in conversion therapy for stage IV gastric cancer / 中华胃肠外科杂志

Gastric cancer is one of the most common malignancy in China. Most of the patients of gastric cancer treated clinically are in advanced stage. In the past years, with the progress of anti-cancer drug therapy, after the comprehensive treatment based on drugs therapy of inoperative stage IV gastric cancer, some cases can reduce the tumor stage and get the opportunity of radical operation. Some of the patients who underwent surgical treatment can get the chance of long-term survival. The results of REGATTA trial confirmed that palliative surgery plus chemotherapy could not improve the long-term survival of patients with stage IV gastric cancer. Neoadjuvant intraperitoneal plus intravenous chemotherapy can reduce the tumor stage of some cases of stage IV gastric cancer with peritoneal metastasis and receive surgical treatment, so as to gain the chance of long-term survival. Regimen of intraperitoneal hyperthermia chemotherapy combined with PHOENIX trial is expected to improve the conversion operation rate of gastric cancer with peritoneal metastasis. Paclitaxel-based three-drug chemotherapy can reduce the tumor stage of some inoperable advanced gastric cancer and obtain the opportunity of radical operation, improving the disease-free survival rate and overall survival rate of patients, thus has become the cornerstone of conversion therapy for stage IV gastric cancer. Antiangiogenic targeted drug apatinib combined with paclitaxel is safe and reliable, and can be used as an alternative for the conversion therapy of stage IV gastric cancer, which provides a new idea for cytotoxic drugs combined with targeted drugs. In the era of immunotherapy, the combined application and first-line application of immunosuppressive drugs has become a clinical consensus. For advanced Her-2 positive esophagogastric junction adenocarcinoma cases, the successful exploration of the four-drug combination of chemotherapy+ anti-Her-2 targeted drugs+ anti-PD1 monoclonal antibody combined with the first-line therapy has opened up a new era of transformational therapy for stage IV gastric cancer. Gastric cancer is a malignant tumor with high heterogeneity, the classification of stage IV gastric cancer represented by Yoshida classification is based on imaging, and a more reasonable classification method should be developed in combination with gene detection in the future. Based on this, an individualized and accurate conversion therapy plan is formulated, so as to effectively improve the long-term survival of patients with stage IV gastric cancer.

Current Situation of Hyperthermic Intraperitoneal Chemotherapy in Peritoneal Carcinoma / 肿瘤防治研究

Peritoneal carcinoma is a kind of malignant tumor which occurs and develops on the peritoneum, including primary and secondary tumors. Hyperthermic intraperitoneal chemotherapy is a combined therapy of intraperitoneal perfusion, hyperthermia and chemotherapy on peritoneal cancer, with satisfactory curative effect. In recent years, with the continuous progress of technology and research, hyperthermic intraperitoneal chemotherapy has become the most effective method for the treatment of peritoneal cancer. In this paper, we review the current situation of hyperthermic intraperitoneal chemotherapy on peritoneal cancer.

Diagnosis and surgical strategies for Siewert type Ⅱ adenocarcinoma of esophagogastric junction / 中华消化外科杂志

The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing year by year. Surgical treatment is the most important treatment in the multidisciplinary comprehensive treatment. Because of the particularity of anatomy and biological behaliars, there are many disputes in surgical treatment. It mainly focuses on the choice of surgical approach, scope of surgical resection and guarantee of the safety of surgical margin, scope of lymph node dissection, choice of digestive tract reconstruction after radical operation, role of neoadjuvant treatment in surgical treatment, etc, which need to be confirmed through more randomized clinical studies. The authors discuss the disputes of the surgical diagnosis and treatment strategies of Siewert Ⅱ AEG in the era of minimally invasive surgery.

Prognostic factors analysis of Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction after radical resection with different surgical approaches / 中华消化外科杂志

Objective:To investigate the prognostic factors of Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG) after radical resection with different surgical approaches.Methods:The retrospective case-control study was conducted. The clinicopathological data of 442 patients who were admitted to Tianjin Medical University Cancer Institute and Hospital from February 2003 to July 2011 were collected. There were 362 males and 80 females, aged from 21 to 85 years, with a median age of 64 years. Patients underwent radical resection of AEG. Observation indicators: (1) surgical situations; (2) follow-up; (3) progrostic factors analysis of AEG after radical resection; (4) survival of patients after radical resection of AEG via abdominal approach; (5) survival of patients after radical resection of AEG via thoracoabdominal approach; (6) survival of patients after radical resection of Siewert type Ⅱ type AEG; (7) survival of patients after radical resection of Siewert type Ⅲ AEG. Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to June 2018. Measurement data with skewed distribution were described as M (range). Count data were expressed as absolute numbers or percentages. Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-rank test was used for survival analysis. Univariate analysis was conducted using the Kaplan-Meier method. Multivariate analysis was conducted using the COX proportional hazard model. Results:(1) Surgical situations: 442 patients underwent radical resection of AEG, including 204 via abdominal approach and 238 via thoracoabdominal approach. There were 391 patients with D 2 lymphadenectomy and 51 with D 2+ lymphadenectomy. (2) Follow-up: 442 patients were followed up for 8-162 months, with a median follow-up time of 37 months. All the 442 patients survived for 2-156 months, with a median survival time of 31 months. The 1-, 3-, 5-year overall survival rates were 79.2%, 42.0%, 30.0%, respectively. (3) Prognostic factors analysis of AEG after radical resection: results of univariate analysis showed that tumor diameter, Lauren type, pathological T staging, pathological N staging, pathological TNM staging, lymphatic vessel invasion, and soft tissue infiltration were related factors for prognosis of patients after radical resection of Siewert type Ⅱ and Ⅲ AEG ( χ2=4.028, 4.885, 19.435, 17.014, 34.449, 9.707, 11.866, P<0.05). Results of multivariate analysis showed that pathological TNM staging, lymphatic vessel invasion, and soft tissue infiltration were independent influencing fators for prognosis of patients after radical resection of Siewert type Ⅱ and Ⅲ AEG ( hazard ratio=1.255, 0.486, 1.454, 95% confidence interval: 1.024-1.539, 0.325-0.728, 1.096-1.928, P<0.05). (4) Survival of patients after radical resection of AEG via abdominal approach: of the 204 patients undergoing radical resection of AEG via abdominal approach, the 1-, 3-, 5-year survival rates were 83.6%, 50.4%, 37.8% for 121 patients with Siewert type Ⅱ AEG, respectively, versus 72.0%, 39.3%, 31.8% for 83 patients with Siewert type Ⅲ AEG, showing no significant difference in the survival between the two groups ( χ2=1.854, P>0.05). (5) Survival of patients after radical resection of AEG via thoracoabdominal approach: of the 238 patients undergoing radical resection of AEG via thoracoabdominal approach, the 1-, 3-, 5-year survival rates were 79.6%, 38.8%, 23.8% for 183 patients with Siewert type Ⅱ AEG, respectively, versus 79.1%, 37.6%, 29.3% for 55 patients with Siewert type Ⅲ AEG, showing no significant difference in the survival between the two groups ( χ2=0.215, P>0.05). (6) Survival of patients after radical resection of Siewert type Ⅱ AEG: of the 304 patients with Siewert typeⅡAEG, the postoperative 1-, 3-, 5-year survival rates were 83.6%, 50.4%, 37.8% for 121 patients undergoing radical resection of AEG via abdominal approach, respectively, versus 79.6%, 38.8%, 23.8% for 183 patients undergoing radical resection of AEG via thoracoabdominal approach, showing no significant difference in the survival between the two groups ( χ2=2.406, P>0.05). (7) Survival of patients after radical resection of Siewert type Ⅲ AEG: of the 138 patients with Siewert type Ⅲ AEG, the postoperative 1-, 3-, 5-year survival rates were 72.0%, 39.3%, 31.8% for 83 patients undergoing radical resection of AEG via abdominal approach, respectively, versus 79.1%, 37.6%, 29.3% for 55 patients undergoing radical resection of AEG via thoracoabdominal approach, showing no significant difference in the survival between the two groups ( χ2=0.640, P>0.05). Conclusions:Pathological TNM staging, lymphatic vessel invasion, and soft tissue infiltration are independent fators for prognosis of patients after radical resection of Siewert type Ⅱ and Ⅲ AEG. Siewert types and surgical approach are not related factors for prognosis of patients after radical resection of AEG. There is no significant difference in the survival between patients with different Siewert types of AEG undergoing radical resection via different surgical approaches.

Progress of perioperative chemotherapy of locally advanced gastric cancer / 国际外科学杂志

Gastrectomy with D2 lymph node dissection has become the global standard procedure for locally advanced gastric cancer. Based on the evidence of the clinic trials, postadjuvant chemotherapy after D2 gastrectomy is the current standard strategy. Neoadjuvant chemotherapy can increase the R0 resection rate, but the consensus has not been reached. These trials could lead to new evidence for improved treatment of gastric cancer in the near future. This review will summarize recent evidence on the benefits of for locally advanced gastric cancer.

Strengthening the quality control of radical gastrectomy for locally advanced gastric cancer / 中华消化外科杂志

The extent of gastrectomy and lymphadenectomy for locally advanced gastric cancer were revised in the 5th Japanese gastric cancer treatment guidelines.The 2018 edition of the Chinese Society of Clinical Oncology (CSCO) guidelines for the diagnosis and treatment of gastric cancer were revised according to the Japanese guidelines.The following items are extremely important for the quality control of radical gastrectomy:lymphadenectomy is carried out straitly according the guidelines,ex vivo lymph nodes are dissected from the specimen by surgeons according the different lymph node groups and the pathological report should contains the number of examined and metastatic lymph nodes of different groups individually.The number of dissected/examined lymph nodes has significant impacts on patients' pathologic staging.In order to avoid the migration of staging,30 and more lymph nodes should be dissected and examined.The experience of surgeons,training and operation volumes are decisive factors for the quality of operation.Centralization and specialization of gastric cancer treatment are shortcuts to improve the quality of radical gastrectomy.

Research progress of esophagogastric junction cancer in the 91st Annual Meeting of Japanese Gastric Cancer Association / 中华消化外科杂志

The 91st Annual Meeting of Japanese Gastric Cancer Association was held in Shizuoka,Japan from 26th February to 1st March,2019.In this article,the author reviewed the analyzed research progress of the esophagogastric junction EGJ cancer in this meeting.Epidemiological data show that in the past 30 years,the incidence of squamous cell carcinoma of the EGJ is gradually decreasing,and the incidence of adenocarcinoma of the esophagogastric junction (AEG) is gradually increasing.Due to the special anatomical position,endoscopic surgery for early EGJ cancer is more demanding.Perioperative therapy is the standard treatment in Europe,which is confirmed by many researches.There were many researches aimed to investigate objective efficacy of neoadjuvant chemoradiotherapy.A multicenter prospective randomized study co-sponsored by the Japanese Society of Gastric Cancer and Society of Esophageal Cancer has answered the controversial clinical question of surgical approach and extent of lymph node dissection for AEG.Reasonable reconstruction of digestive tract after proximal gastrectomy is challenging.The proximal gastric tube interposition has clinical rationality,and the transhiatal approach should be chosen for jejunal interposition and double tract reconstruction.The reconstruction of lower esophageal sphincter was achieved by Kamikawa method,however,its indication should be strictly controlled.