Current status and prospect of perioperative treatment of locally advanced gastric cancer / 中华消化外科杂志

Gastric cancer is one of the common digestive tract malignant tumors. Locally advanced gastric cancer has a large tumor load, mostly small metastatic lesions, and a high risk of recurrence. The comprehensive treatment strategy of "radical operation with D 2 lymph node dissec-tion and perioperative treatment" has gradually become the standard treatment mode for locally advanced gastric cancer. In recent years, there have been breakthroughs in perioperative treatment of locally advanced gastric cancer by radiotherapy, targeted therapy and especially immunotherapy. In this article, the authors analyze the research progress of perioperative treatment of locally advanced gastric cancer at home and abroad, systematically describe the current status and prospect of perioperative treatment of locally advanced gastric cancer.

Application value of Overlap guiding tube in Overlap esophagojejunostomy of laparoscopic total gastrectomy / 中华消化外科杂志

Objective:To investigate the application value of Overlap guiding tube (OGT) in Overlap esophagojejunostomy of laparoscopic total gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients with gastric cancer who were admitted to Nanfang Hospital of Southern Medical University from June to July in 2021 were collected. There were 3 males and 2 females, aged from 48 to 61 years, with a median age of 54 years. Patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative anastomotic stenosis and esophageal reflux up to September 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(IQR) or M(range). Count data were represented as absolute numbers. Results:(1) Surgical situations: 5 patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy and D 2 lymph node dissection success-fully, achieving R 0 resection. There was no combined organ resection, intraoperative conversion to laparotomy or combined thoracotomy. There was no intraoperative conversion to other esophagoje-junostomy method either. The tumor diameter, length of surgical incision, the number of lymph nodes dissected, time of esophagojejunal anastomosis, time of digestive reconstruction, operation time, volume of intraoperative blood loss of 5 patients were 3.0(2.8)cm, 5.0(2.0)cm, 47.0(21.0), 21.0(5.0)minutes, 62.0(23.0)minutes, 295.0(75.0)minutes, and 50.0(60.0)mL, respectively. The anvil fork of linear stapler was successfully inserted into esophageal lumen by once operation in 4 cases of 5 patients and by twice operation in 1 case to complete the esophagojejunostomy. (2) Post-operative situations: the time to first out-of-bed activities, time to postoperative first anal flatus, time to postoperative initial liquid diet intake, time to postoperative initial semi-liquid diet intake, time to abdominal drainage tube removal, duration of postoperative hospital stay of 5 patients were 2.0(1.0)days, 3.0(2.0)days, 4.0(3.0)days, 6.0(3.0)days, 7.0(4.0)days, and 9.0(6.0)days, respectively. Results of postoperative pathological examination of 5 patients showed gastric adenocar-cinoma in all the 5 patients, with the TNM staging as stage pT2-4aN0M0. The esophageal surgical margin was negative in all cases, and the length of proximal margin from esophagus was 5.0(4.0)cm. None of the 5 patients developed anastomotic leakage, anastomotic bleeding or anastomotic stenosis. Two cases with mild pneumonia (Clavien-Dindo grade Ⅱ) were cured by conservative treatment such as anti-infection and expectoration promotion. There was no unplanned secondary surgery or perioperative death occurred to the 5 patients. (3) Follow-up: 5 patients were followed up for 3 months. None of the 5 patients developed anastomotic stenosis or esophageal reflux during the follow-up. Conclusion:OGT-assisted Overlap esophagojejunostomy of laparoscopic total gas-trectomy is safe and feasible, with good short-term effects.

Vascular injury and anatomy during laparoscopy - assisted distal gastrectomy with D2 lymphadenectomy for gastric cancer / 中华胃肠外科杂志

Objective@#To evaluate the incidence of intraoperative vascular injury (IVI) and associated anatomical features during laparoscopy - assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer.@*Methods@#A descriptive cohort study was performed. Clinical data and operational videos of 278 consecutive gastric cancer patients who underwent LADG with D2 lymphadenectomy for gastric cancer at Department of General Surgery of Nanfang Hospital between January 2010 and December 2017 were retrospectively analyzed. IVI and vascular anatomy during lymphadenectomy were observed and recorded in the following four scenes: scene I: No. 4sb and No.4d of lower left (tail of pancreas) area; scene II: No.6 of lower right (subpyloric) area; scene III: No.5 and No.12a of upper right (suprapyloric) area; scene IV: No. 7, No. 8a, No. 9, No. 11p of central area posterior to the gastric body. IVI was defined as the injury of main perigastric vessel requiring additional procedure for hemostasis such as electrocauterization, gauze compression, clipping or suture.@*Results@#Among 278 patients, 125 (45.0%) had IVI. Two cases of IVI required conversion to open operation and the injuried vascular was left gastric artery (LGA) and right gastric artery (RGA), respectively. Higher incidence of IVI was found in scene II (92/278, 33.1%) and scene IV(39/278, 14.0%). More common IVI was observed in right gastroepiploic vein (RGeV, 57/278, 20.5%) and left gastric vein (LGV, 33/278, 11.9%). The right gastroepiploic vessels were observed in all 278 patients, including 3 (1.1%) cases with 2 RGeVs, and 2 cases with 2 right gastroepiploic arteries (RGeA). RGA was observed clearly in 265 (95.3%) patients, whose ramification pattern was as follows: from proper hepatic artery (PHA, 223/265, 84.2%), from gastroduodenal artery (GDA, 16/265, 6.0%), from left hepatic artery (LHA, 12/265,4.5%), from the crossing of PHA and GDA (8/265, 3.0%), and 6 (2.3%) patients with 2 RGAs simultaneously from PHA and GDA, respectively. The most common injury of RGA (4/12) occurred in LHA. Excluding 2 cases of conversion to open surgery due to intraoperative hemorrhage, among 276 patients, LGV was observed in 270 patients (97.1%), whose drainage pattern was as follows: into the portal vein (PV, 148/270, 54.8%), into the spleen vein (SV, 56/270, 20.7%), into the junction of these two veins (52/270, 19.3%), into left portal vein (LPV, 8/270, 3.0%), meanwhile 6 patients had 2 LGVs simultaneously, including LGVs of 5 cases into PV and SV, and of 1 case into PV-SV junction and SV. The most common IVI was found in those patients with two LGVs (4/6).@*Conclusions@#IVI during LADG with D2 lymphadenectomy is common. The highest risk of IVI is found in scene II and scene IV. Attentions should be paid to anatomic variation of vessels, especially the RGeV, LGV and RGA.

Application and effect evaluation of an self-made device to fix liver in laparoscopic radical gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To introduce the application and clinical effect of self-made liver fixing device in laparoscopic radical gastrectomy.</p><p><b>METHODS</b>Clinical data of 469 patients underwent laparoscopic radical gastrectomy in Nanfang Hospital, Southern Medical University from March 2014 to January 2017 were analyzed retrospectively. In laparoscopic radical gastrectomy, self-made liver fixing device was used to expose surgical field covered by hepatic lobe in gastric lesser curvature and hepatic flexure of colon. Manufacture of the self-made liver fixing device: appropriate length of the catheter was cut according to the size of liver; the lotus suture needle with a thread was put through two catheters to connect them. Then the prepared liver fixing device was sent into abdominal cavity through a 12-mm Trocar hole with needle holder and was fixed on the free hepatic lateral hepatogastric ligament with hemo-lock. Finally the application effect of the liver fixing device was evaluated by reviewing the surgical videos.</p><p><b>RESULTS</b>A mean time of 40.3 seconds was required to complete liver fixing by using the self-made liver fixing device in laparoscopic radical gastrectomy and liver did not slip down in all the cases. Liver secondary manual fixing by assistants was 2 times averagely. Three cases had mild liver injury.</p><p><b>CONCLUSION</b>The self-made liver fixing device in laparoscopic radical gastrectomy is easy to operate and can effectively expose sufficient surgical field, with high security and convenient materials.</p>

Analysis of medical functional dispersal in Beijing based on capital formation account / 中国卫生政策研究

Objective:To provide policy recommendations for Beijing public health departments to grasp the dy-namic allocation of healthcare resources and the advantage of medical functional dispersal, and making appropriate health policies to rationally adjust the allocation of health resources. Methods:To study the dynamic function of Bei-jing medical, this study uses the method of accounting of cases summary of the annual report on health finance through the descriptive analysis of the gross fixed capital formation in various regional government-run health facili-ties. Results:The results of this study show that the quality of medical health administrative resources was higher, but effectively dispersed in 2015. By contrast, the basic public health resources allocation was unbalanced. Conclu-sion:This study puts forward the corresponding health policy suggestions. On one hand, it is important to make fur-ther policy to encourage high quality medical resources to be effectively relieved and the regional planning should be done according to market demand by avoiding the blind construction at the early stages. On the other hand, much at-tention should be paid on the balanced development of the basic public health service ability and the coordinated de-velopment of administrative capacity in health, and supporting policies should be formulated, which should rationally allocate the public health resources for a better overall medical functional dispersal.

Evaluation of embryo toxicity of Shuanghuanglian based on human placental barrier model / 中国药理学与毒理学杂志

OBJECTIVE To evaluate the embryo toxicity of Shuanghuanglian (SHL) by the combination of a human placental barrier model and embryonic stem (ES) cell test model.METHODS A human placental barrier model was set up by placenta slice culture and Ussing chamber.SHL 0.2,0.4,0.8,1.6,3.2,6.4 and 12.8 g· L-1 was added into the maternal side of the human placental model,respectively.All the media was collected respectively from the matemal side and fetal side 60 min later and taken as the SHL containing medium.ES cells (D3 line) and embryonic fibroblast cells (BALB/c 3T3) were cultured with the SHL containing medium respectively from the maternal side and the fetal side for 10 d.Cell viability was detected by MTT assay,and 50％ survival inhibitory ratio of ES and 3T3 cells by SHL was calculated.ES cells were incubated with the SHL containing medium from the matemal side or fetal side when they differentiated to cardiac myoblasts using hanging drop-suspension-attachment method.Messenger RNA of myosin heavy chain genes (β-MHC) was detected by Q-PCR for differentiation ratio,and 50％ differentiation inhibitory ratio of ES cells by SHL was calculated.A statistics formula was used for prediction of SHL embryotoxicity potential.RESULTS The IC50 of SHL in the matemal side of the human placental model for 3T3 cell survival,ES cell survival and ES differentiation was 1.97,0.84 and 0.48 g· L-1,respectively.According to the criteria for embryo toxicity evaluation,SHL had weak embryo toxicity.However,the IC50 of SHL in the fetal side of the human placental model for 3T3 cell survival,ES cell survival and ES differentiation was 3.19,2.57 and 0.95 g· L-1,respectively.According to the criteria for embryo toxicity evaluation,the supernatant containing SHL that went through the placental barrier had no embryo toxicity.CONCLUSION SHL is safe in the test concentration range during pregnancy.It is more scientific to evaluate embryo toxicity of drugs by ES cell test with the samples obtained through the placental barrier during pregnancy.

Relationship analysis between health expenditure and GDP based on health outcomes / 中国卫生政策研究

Objective:To put forward some suggestions for the national health development in the filed of health expenditure indicators .Methods:Two health expenditure indicators and four health outcomes indicators were chosen from WB and WHO official websites , and researches on the relationship between health expenditure and outcomes were conducted .We put forward proposed value of the health cost indicator .Results: With different levels of GDP per capita , the scatter diagram of health expenditure and GDP per capita had different rules .When health outcomes were taken into consideration , the rules were the same .When GDP per capita was at different level , better health outcomes were not related to higher health expenditure .Input-output ratio should be taken into consideration fully . Suggestions:The study should be dynamic as GDP develops .More factors can be added in the research , if the data of the factors is available .In this study , the GDP per capita was divided into 4 sections .The division standard of the GDP per capita can be more delicate .What is more important for the development of health expenditure is not contin-uing input , but better input-output ratio because of diminishing of marginal returns .One set of standards cannot be a-dapted to all countries and districts .We should give full consideration to the improvement of people's health instead of increasing input because the ultimate goal is the former .

Research progression on preoperative mechanical bowel preparation for elective colorectal surgery / 中华胃肠外科杂志

Preoperative mechanical bowel preparation (MBP) has been established as a standard procedure for elective colorectal surgery in most surgical centers since 1950s. However, the routine use of MBP for elective colorectal surgery is still in debate, as the researches on the evaluation of MBP have been carried out in recent 20 years. By searching and analyzing the existing evidence, we conclude that MBP should be routinely abandoned for elective open colorectal surgery, but should be routinely used for elective laparoscopic rectal surgery, and it still awaits large-scale RCTs for further evaluation of MBP for elective laparoscopic colonic surgery.

Simultaneous Determination of the Contents of 8 Ingredients of Shuanghuanglian Freeze-dried Powder in Pla-cental Perfusate / 中国药房

OBJECTIVE:To establish a method for the simultaneous determination of the contents of Shuanghuanglian freeze-dried powder in placental perfusate. METHODS:HPLC was performed on the column of Agilent Zorbax-C18 with mobile phase of acetonitrile-1%formic acid aqueous solution(gradient elution)at flow rate of 1.0 ml/min,the internal standard was puera-rin,detection wavelength was 280 nm,column temperature was 25 ℃ and sample volume was 10 μl. RESULTS:There was a lin-ear range between linear ranges and peak area of 8 ingredients(r≥0.999 0);RSDs of within-day and inter-day precision tests were no more than 1.9%,repeatability tests was no more than 7.3%;average recoveries were in the range of 92.73%-112.37%(RSD=3.2%-8.2%,n=6);and average matrix effects were 90.33%-105.78%(RSD=3.2%-8.0%,n=6). CONCLUSIONS:The method is rapid,sensitive and specific,and can be used to the simultaneous determination of the contents of 8 ingredients of Shuan-ghuanglian freeze-dried powder in placental perfusate.

Identification of Sulfur Fumigated Chrysanthemi Flos with Electronic Nose Technology / 世界科学技术-中医药现代化

This study was aimed to identify Chrysanthemi Flosbefore and after sulfur fumigation based on its different odour by the electronic nose technology.It was expected to explore a new method for the Chrysanthemi Flos identification according to the odour.The electronic nose technology was used in the detection of peak response values of Chrysanthemi Flos on sensor array.The principal component analysis (PCA) and 10 machine learning (ML) ways were used in the analysis of response values and establishment of optimized identification models.The results showed that there was a significant difference in the odour between sulfur fumigated Chrysanthemi Flos and non-sulfur fumigated ones.The identification models were successful with high correct judge rate by PCA and 6 ML ways including BF Tree,J48 and Random Tree.It was concluded that the electronic nose technology can be used for the accurate identification of sulfur fumigated Chrysanthemi Flos and non-sulfur fumigated ones.The electronic nose technology combined with multiple ML methods can be introduced in the quality evaluation of Chrysanthemi Flos.It provided more ideas for the application of electronic nose in data mining for traditional Chinese medicine (TCM) studies.

Quality and quantity classification models of Fructus Amomi applying electronic nose with multiple mathematical statistics methods / 国际药学研究杂志

Objective Fructus Amomi(Sharen) is derived from the dry ripe fruit of Amomum villosum Lour., A.villosum Lour. var. xanthioides T.L. Wu et Senjen and A.longiligulate T.L.Wu, which is widely utilized for its clinic effects on digestive system. However, Fructus Amomi from different species and habitats, possessing different quality, is difficult to identify. In this study, we aim to develop a simple, rapid and reliable method for authentication of Fructus Amomi. Methods Twenty-five batches of samples of Fructus Amomi were collected and electronic nose was introduced into analyzing their odor with multiple mathematical statistics methods. Na?ve bayes network (NBN), radical basis function (RBF) and random forest (RF) were applied to establish different classifiers while BestFirst+CfsSubsetEval (BC) was used to screen the attributes for searching sensor array with higher contributions. Results Firstly, after attribute-screening via BC, the established discriminative models via NBN, RBF and RF could successfully identify genuine and non-genuine samples, presenting correct judging ratios of 78% and 84% through ten-fold cross validation and external test set validation, respectively. Besides, quantity predictive models were constructed as well. In case of content of bornyl acetate, one of the effective components in Fructus Amomi, values were higher than 3.5 mg/g and lower than 1.8 mg/g with sensor response of 0.04 and 0.03, respectively. Conclusion In this paper, quality discriminative model and quantity predictive model of Fructus Amomi were established via electronic nose and multiple mathematical statistics methods. It indicates that electronic nose could be a promising method for quality evaluation of Chinese material medica.

Investigation of Cost Basic Data Availability of Public Traditional Chinese Medicine ;Hospitals / 中国中医药信息杂志

Objectives To understand essential basis data availability for implementation of cost accounting in TCM hospitals. Methods Costs of a total of 1588 TCM hospitals were investigated by conducting the baseline survey via questionnaires in 2013. Results Departmental basic data (including ratio of office staff and entire staff, ratio of outpatient and inpatient departments in clinical department), and construction data for housing were well accessible, while utility fee and internal service data were not. Conclusion ①Public TCM hospitals need to improve and specify the basic cost data. ②Differences exit among different types and levels of hospitals in the availability of data. ③There are still difficulties in carrying out cost accounting in public TCM hospitals, which needs strong supports from all relevant departments.

Anatomy of the perigastric vessels in laparoscopy-assisted distal gastrectomy with D2 lymphadenectomy for gastric cancer / 中华胃肠外科杂志

The laparoscopic approach is rapidly becoming the preferred method of treatment for patients with early gastric cancer due to advantages of minimally invasive surgery. As laparoscopic experience has accumulated, laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy has become a valuable alternative for the treatment of patients with advanced gastric cancer. However, laparoscopic gastric surgery is demanding from a technical point of view, especially when a D2 lymphadenectomy is performed. Surgeons seeking to undertake LADG are concerned about unpredictable intraoperative bleeding that may occur during LADG. Comprehensive knowledge of the perigastric vascular anatomy is essential for LADG with D2 lymphadenectomy.

Autologous platelet-rich plasma and autologous bone graft for comminuted fractures：randomized controlled follow-up / 中国组织工程研究

BACKGROUND:Studies showed that platelet-rich plasma + bone transplantation for repair of bone defects not only can accelerate new bone formation, but also increase bone density. OBJECTIVE:To observe autologous platelet-rich plasma and autologous bone graft for treatment of comminuted fractures, and the efficacy. METHODS:This was a clinical prospective randomized controled study. A total of 42 patients with limb comminuted fracture and bone defects were enroled and randomly assigned to two groups. In the experimental group, 20 patients received treatment with autologous platelet-rich plasma and mixture of autologous ilium and cancelous bone. In the control group, 22 patients underwent plate, screw or intramedulary nail fixation. At 1, 3, 6 and 12 months after surgery, X-ray examination was conducted. Healing conditions, healing speed and functional recovery were compared between the experimental and control groups. RESULTS AND CONCLUSION:The time of bone healing was respectively 12 weeks in the experimental group and 18 weeks in the control group on average, showing significant differences. There were two cases of plate breakage, one case of nonunion reoperation, three cases of delayed fracture healing in the control group. No autologous blood transfusion or other complications appeared in the experimental group. Results suggested that autologous platelet-rich plasma and autologous bone graft for comminuted fractures can facilitate and accelerate bone healing.

Laparoscopic extended right hemicolectomy with D3 lymphadenectomy using a medial-to-lateral approach / 中华消化外科杂志

Lapareseopic colectomy is commonly performed,but laparoscopic extended right hemicolectomy with D3 lymphadenectomy for cancer located at hepatic flexure of the colon is a complex procedure,even in the hands of experts.Laparoscopic dissection of the lymph nodes around the middle colonic and right gastroepiploic vessels are so complicated that precise vascular anatomy and surgical plane are essential to complete this procedure safely.We herein describe a standard technique for performing laparoscopic extended right hemicolectomy with D3 lymphadenectomy using a medial-to-lateral approach.The main surgical plane of this procedure is the right Toldt's space.The superior mesenteric vein (SMV) is the most important anatomical landmark of vascular dissection.Medial-to-lateral approach makes it easy to locate the right Toldt's space and the SMV.

Clinical value of transorally inserted anvil in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer / 中华消化外科杂志

ObjectiveTo evaluate the safety and feasibility of esophagojejunostomy using transorally inserted anvil ( OrVilTM ) after laparoscopic total gastrectomy for gastric cancer.MethodsThe clinical data of 8 patients with advanced gastric cancer who were admitted to the Nanfang Hospital of Southern Medical University from January 2011 to Febuary 2012 were retrospectively analyzed.Laparoscopic total gastrectomy + D2 lymph node dissection was first performed,and then esophagojejunostomy was completed using OrVilTM. Perioperative condition and prognosis of the patients were analyzed.ResultsAll the procedures were completed successfully,with no complications occurred.There was no extension of the incisiou during operatiou.The mean operation time,anvil inserting time and volume of operative blood loss were (203 + 38 ) minutes,( 10 -+ 4) minutes and ( 106 ± 18 )ml,respectively.Tumor-free proximal margins were confirmed by pathological examination in all the patients.The mean time to first flatus,time to liquid and semi-liquid diet and duration of hospital stay were (3.5 ± 1.3 )days,(5.5 ± 2.9 ) days,( 7.5 ± 3.2) days and ( 11.5 ± 3.5 ) days.The mean time of follow-up was 10 months ( rauge,1-14 months),no anatomosis-related complications were observed.Conclusion Esophagojejunostomy using OrVilTM after laparoscopic total gastrectomy for gastric cancer is safe and feasible.

Comparison of long-term oncological outcomes of laparoscopic and open resection of rectal cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the long-term oncological outcomes of laparoscopic and open resection of rectal cancers.</p><p><b>METHODS</b>Between January, 2003 and December, 2008, 514 patients with rectal cancer were admitted in our hospital, among whom 186 underwent laparoscopic tumor resection and 238 received open radical resection of the tumors. The long-term survival of the patients and the recurrence pattern were compared between the two groups.</p><p><b>RESULTS</b>The median follow-up of the patients was 48.54∓28.76 months. No significant differences were found between the two groups in the local recurrence rate (3.9% vs 5.5%, P=0.284), 5-year overall survival (69.4% vs 61.3%, P=0.067), or the 5-year disease-free survival rates (67.7% vs 60.7%, P=0.110). Both the 5-year overall survival and progression-free survival of the patients in stage IV were better in the laparoscopic group than in the open surgery group (P<0.05).</p><p><b>CONCLUSION</b>Laparoscopic resection of rectal cancer can achieve long-term oncological outcomes comparable to those of conventional open surgery.</p>

Establishing the regeneration system of sunflower / 生物工程学报

In order to establish a high efficient regeneration system of sunflower, we optimized the process of callus induction, differentiation and rooting by screening the optimum genotype, explant materials, hormone and cytokine concentration and additives. The results indicated that hybrid sunflowers were easier to regenerate than selfing ones; The best explant was four days cotyledon. The optimum induction medium was Murashige and Skoog (MS) + 2.0 mg/L 6-benzyladenine (6-BA) + 0.5 mg/L naphthaleneacetic acid (NAA) + 1.0 mg/L kinetin (KT). The maximum rate of callus induction was 100%. The optimum differentiation medium was MS +0.2 mg/L 6-BA + 0.5 mg/L NAA + 0.3 mg/L KT + 0.3 mg/L silver nitrate (AgNO3) + 0.2 g/L active carbon (AC), and the buds differentiation rate was up to 71%. The best rooting culture medium was 1/2 MS + 0.6 mg/L indolebutyric acid (IBA). The highest rooting rate was 77%. The analysis of variance showed that genotype, explants growth time, different kinds and concentration of hormone, AC concentration had a significant effect on sunflower regeneration.