The safety and short-term effect of mixed approach in laparoscopic right hemicolectomy for right colon cancer compared with middle approach: a retrospective study.

PURPOSE: To investigate whether the mixed approach is a safe and advantageous way to operate laparoscopic right hemicolectomy. METHODS: A retrospective study was performed on 316 patients who underwent laparoscopic right hemicolectomy in our center. They were assigned to the middle approach group (n = 158) and the mixed approach group (n = 158) according to the surgical approaches. The baseline data like gender、age and body mass index as well as the intraoperative and postoperative conditions including operation time, blood loss, postoperative hospital stay and complications were analyzed. RESULTS: There were no significant differences in age, sex, BMI, ASA grade and tumor characteristics between the two groups. Compared with the middle approach group, the mixed approach group was significantly lower in terms of operation time (217.61 min vs 154.31 min, p < 0.001), intraoperative blood loss (73.8 ml vs 37.97 ml, p < 0.001) and postoperative drainage volume. There was no significant difference in the postoperative complications like postoperative anastomotic leakage, postoperative infection and postoperative intestinal obstruction. CONCLUSIONS: Compared with the middle approach, the mixed approach is a safe and advantageous way that can significantly shorten the operation time, reduce intraoperative bleeding and postoperative drainage volume, and does not prolong the length of hospital stay or increase the morbidity postoperative complications.

Analysis of the current status of TB transmission in China based on an age heterogeneity model.

Tuberculosis (TB) is an infectious disease transmitted through the respiratory system. China is one of the countries with a high burden of TB. Since 2004, an average of more than 800,000 cases of active TB has been reported each year in China. Analyzing the case data from 2004 to 2018, we found significant differences in TB incidence by age group. A model of TB is put forward to explore the effect of age heterogeneity on TB transmission. The nonlinear least squares method is used to obtain the key parameters in the model, and the basic reproduction number Rv = 0.8017 is calculated and the sensitivity analysis of Rv to the parameters is given. The simulation results show that reducing the number of new infections in the elderly population and increasing the recovery rate of elderly patients with the disease could significantly reduce the transmission of TB. Furthermore, the feasibility of achieving the goals of the World Health Organization (WHO) End TB Strategy in China is assessed, and we obtained that with existing TB control measures it will take another 30 years for China to reach the WHO goal to reduce 90% of the number of new cases by the year 2049. However, in theory it is feasible to reach the WHO strategic goal of ending TB by 2035 if the group contact rate in the elderly population can be reduced, though it is difficult to reduce the contact rate.

Dynamics analysis of an SVEIR epidemic model in a patchy environment.

In this paper, we propose a multi-patch SVEIR epidemic model that incorporates vaccination of both newborns and susceptible populations. We determine the basic reproduction number $ R_{0} $ and prove that the disease-free equilibrium $ P_{0} $ is locally and globally asymptotically stable if $ R_{0} < 1, $ and it is unstable if $ R_{0} > 1. $ Moreover, we show that the disease is uniformly persistent in the population when $ R_{0} > 1. $ Numerical simulations indicate that vaccination strategies can effectively control disease spread in all patches while population migration can either intensify or prevent disease transmission within a patch.

A Mathematical Model to Study the Potential Hepatitis B Virus Infections and Effects of Vaccination Strategies in China.

MOTIVATIONS: Hepatitis B is a potentially life-threatening infectious disease caused by the hepatitis B virus (HBV). Approximately 390,000 people in China die from HBV-related diseases each year. Around 86 million individuals suffer from infections of the hepatitis B virus, accounting for about 6% of the total population in the region. There are approximately 30 million chronic infections. From 2002 to 2007, China's government took part in "The Global Alliance for Vaccines and Immunization (GAVI)" initiative, which helped reduce cases of chronic HBV infections among children. However, incidences of hepatitis B remain persistently high in China. Accurately estimating the number of potential HBV infections is crucial for preventing and controlling the transmission of the hepatitis B virus. Up until now, there were no studies of potentially infectious hepatitis B virus infections. METHODS: this study was based on data from the National Bureau of Statistics of China from 2003 to 2021; a dynamic model was built, which included a compartment for potentially infectious hepatitis B virus infections. The parameters in the model were fitted using a combination of nonlinear least-squares and genetic algorithm methods. RESULTS: the calculated reproduction number for hepatitis B virus transmission within the population is Rc = 1.741. Considering the existing vaccine inefficiency rate of 0.1, the model estimates there are 449,535 (95%CI [415,651, 483,420]) potentially infectious hepatitis B virus infections, constituting 30.49% of total hepatitis B cases. Date fitting using MATLAB reveals that increasing the rate of hepatitis B vaccinations can effectively reduce the number of infections. CONCLUSIONS: the results reveal that the number of potential infectious hepatitis B virus infections is so high that the number of hepatitis B patients persistently rises in China. To better control the transmission of the hepatitis B virus, an optional prevention and control strategy is needed to increase the vaccination of different age groups, and it is necessary to help the public correctly understand the transmission of hepatitis B and ensure adequate protection.

A study on the transmission dynamics of COVID-19 considering the impact of asymptomatic infection.

The COVID-19 epidemic has been spreading around the world for nearly three years, and asymptomatic infections have exacerbated the spread of the epidemic. To analyse and evaluate the role of asymptomatic infections in the spread of the epidemic, we establish an improved COVID-19 infectious disease dynamics model. We fit the epidemic data in the four time periods corresponding to the selected 614G, Alpha, Delta and Omicron variants and obtain the proportion of asymptomatic persons among the infected persons gradually increased and with the increase of the detection ratio, the cumulative number of cases has dropped significantly, but the decline in the proportion of asymptomatic infections is not obvious. Therefore, in view of the hidden transmission of asymptomatic infections, the cooperation between various epidemic prevention and control policies is required to effectively curb the spread of the epidemic.

Modeling COVID-19 transmission dynamics incorporating media coverage and vaccination.

The COVID-19 pandemic has caused widespread concern around the world. In order to study the impact of media coverage and vaccination on the spread of COVID-19, we establish an SVEAIQR infectious disease model, and fit the important parameters such as transmission rate, isolation rate and vaccine efficiency based on the data from Shanghai Municipal Health Commission and the National Health Commission of the People's Republic of China. Meanwhile, the control reproduction number and the final size are derived. Moreover, through sensitivity analysis by PRCC (partial rank correlation coefficient), we discuss the effects of both the behavior change constant $ k $ according to media coverage and the vaccine efficiency $ \varepsilon $ on the transmission of COVID-19. Numerical explorations of the model suggest that during the outbreak of the epidemic, media coverage can reduce the final size by about 0.26 times. Besides that, comparing with $ 50\% $ vaccine efficiency, when the vaccine efficiency reaches $ 90\% $, the peak value of infected people decreases by about 0.07 times. In addition, we simulate the impact of media coverage on the number of infected people in the case of vaccination or non-vaccination. Accordingly, the management departments should pay attention to the impact of vaccination and media coverage.

An improved method of global dynamics: Analyzing the COVID-19 model with time delays and exposed infection.

Considering the transmission characteristics of the coronavirus disease 2019 (COVID-19), there are certain time delays in the transition from susceptible individuals to exposed individuals after contact with exposed, symptomatically infected, and asymptomatically infected individuals. A COVID-19 model with time delays and exposed infection is developed and then the global dynamics of this model is investigated by an improved method; moreover, the numerical simulations are carried out. It is shown that the COVID-19-free equilibrium T0 is globally asymptotically stable (GAS) if and only if the control reproduction number Rc≤1, while T0 is unstable and the COVID-19 equilibrium T∗ is GAS if and only if Rc>1. The numerical results reveal that strengthening quarantine measures is helpful to control the COVID-19 epidemic in India. Furthermore, when Rc<1, the numbers of symptomatically infected, asymptomatically infected, and quarantined individuals eventually tend to the zero equilibrium state, and with the increase in the time delay, the three kinds of variables change faster and their peaks become larger; when Rc>1, the three kinds of variables eventually tend to the positive equilibrium state, which are oscillatory and the amplitudes of the oscillation enlarge as the value of time delay increases. The numerical results show that when Rc<1, the smaller the value of time delay, the smaller the final epidemic size. In short, the longer it takes time for susceptible individuals to transform exposed individuals, the harder COVID-19 will be controlled.

Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node.

Background: Resectable gastric cancer (GC) patients with small para-aortic lymph node (smaller than 10mm in diameter, sPAN) were seldom reported, and existing guidelines did not provide definite treatment recommendation for them. Methods: A total of 667 consecutive resectable GC patients were enrolled. 98 patients were in the sPAN group, and 569 patients without enlarged para-aortic lymph node were in the nPAN group. Standard D2 lymphadenectomy was performed. Neoadjuvant and adjuvant chemotherapy were administrated according to the cTNM and pTNM stage, respectively. Clinicopathological features and prognosis were compared between these two groups. Results: The median size of sPAN was 6 (range, 2-9) mm and the distribution was prevalent in No. 16b1. cN stage (p=0.001) was significantly related to the presence of sPAN. sPAN was both independent risk factor for OS (p=0.031) and RFS (p=0.046) of all patients. The prognosis of patients with sPAN was significantly worse than that of patients with nPAN (OS: p=0.008; RFS: p=0.007). Preoperative CEA and CA19-9 were independent risk factors for prognosis of patients with sPAN. Furthermore, patients in the sPAN group with normal CEA and CA19-9 exhibited acceptable prognosis (5-year OS: 67%; RFS: 64%), while those with elevated CEA or CA19-9 suffered significantly poorer prognosis (5-year OS: 17%; RFS: 17%) than patients in the nPAN group (5-year OS: 64%; RFS 62%) (both p < 0.05). Conclusions: Standard D2 lymphadenectomy should be considered a valid approach for GC patients with sPAN associate to normal preoperative CEA and CA19-9 levels. Patients with sPAN associated to elevated CEA or CA19-9 levels could benefit from a multimodal approach: neoadjuvant chemotherapy; radical surgery with D2 plus lymph nodal dissection extended to No. 16 station.

Identification of a three-gene prognostic signature for radioresistant esophageal squamous cell carcinoma.

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is causing a high mortality rate due to the lack of efficient early prognosis markers and suitable therapeutic regimens. The prognostic role of genes responsible for the acquisition of radioresistance in ESCC has not been fully elucidated. AIM: To establish a prognostic model by studying gene expression patterns pertinent to radioresistance in ESCC patients. METHODS: Datasets were obtained from the Gene Expression Omnibus and The Cancer Genome Atlas databases. The edgeR, a Bioconductor package, was used to analyze mRNA expression between different groups. We screened genes specifically responsible for radioresistance to estimate overall survival. Pearson correlation analysis was performed to confirm whether the expression of those genes correlated with each other. Genes contributing to radioresistance and overall survival were assessed by the multivariate Cox regression model through the calculation of ßi and risk score using the following formula: . RESULTS: We identified three prognostic mRNAs (cathepsin S [CTSS], cluster of differentiation 180 [CD180], and SLP adapter and CSK-interacting membrane protein [SCIMP]) indicative of radioresistance. The expression of the three identified mRNAs was related to each other (r > 0.70 and P < 0.05). As to 1-year and 3-year overall survival prediction, the area under the time-dependent receiver operating characteristic curve of the signature consisting of the three mRNAs was 0.716 and 0.841, respectively. When stratifying patients based on the risk score derived from the signature, the high-risk group exhibited a higher death risk and shorter survival time than the low-risk group (P < 0.0001). Overall survival of the low-risk patients was significantly better than that of the high-risk patients (P = 0.018). CONCLUSION: We have developed a novel three-gene prognostic signature consisting of CTSS, CD180, and SCIMO for ESCC, which may facilitate the prediction of early prognosis of this malignancy.

Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single-center prospective cohort study.

BACKGROUND: Anastomotic leakage (AL) is one of the common complications after rectal cancer surgery. This study aimed to evaluate the combination of biomarkers for the early prediction of symptomatic AL after surgery. METHODS: A prospective cohort study evaluated the serum and peritoneal biomarkers of patients who underwent laparoscopic low anterior resection (Lap LAR) from November 1, 2021, to May 1, 2022. Multivariate-penalized logistic regression was performed to explore the independent biomarker with a P-value <.1, and receiver operating characteristic (ROC) curve was used to analyze the area under the curve (AUC), sensitivity, and specificity of the independent biomarkers. A predictive model for symptomatic AL was built based on the independent biomarkers and was visualized with a nomogram. The calibration curve with the concordance index (c-index) was further applied to evaluate the efficacy of the predictive model. RESULTS: A total of 157 patients were included in this study, and 7 (4.5%) were diagnosed with symptomatic AL. C-reactive protein/album ratio (CAR) on postoperative day 1 and systemic immune-inflammation index (SII) and peritoneal interleukin-6 (IL-6) on postoperative day 3 were proven to be independent predictors for the early prediction of symptomatic AL. The optimal cutoff values of CAR, SII, and peritoneal IL-6 were 1.04, 916.99, and 26430.09 pg/ml, respectively. Finally, the nomogram, including these predictors, was established, and the c-index of this nomogram was 0.812, indicating that the nomogram could be used for potential clinical reference. CONCLUSION: The combination of CAR, SII, and peritoneal IL-6 might contribute to the early prediction of symptomatic AL in patients following Lap LAR. Given the limitations of this study and the emergence of other novel biomarkers, multicenter prospective studies are worthy of further exploration.

The validity of neoadjuvant chemotherapy with paclitaxel plus S-1 is not inferior to that of SOX regimen for locally advanced gastric cancer: an observational study.

BACKGROUND: Paclitaxel plus S-1(PTXS) has shown definite efficacy for advanced gastric cancer. However, the efficacy and safety of this regimen in neoadjuvant setting for locally advanced gastric cancer (LAGC) are unclear. This study aimed to compare the efficacy of neoadjuvant chemotherapy (NAC) PTXS and oxaliplatin plus S-1 (SOX) regime for patients with LAGC. METHODS: A total of 103 patients with LAGC (cT3/4NanyM0/x) who were treated with three cycles of neoadjuvant SOX regimen (n = 77) or PTXS regimen (n = 26) between 2011 and 2017 were enrolled in this study. NAC-related clinical response, pathological response, postoperative complication, and overall survival were analyzed between the groups. RESULTS: The baseline data did not differ significantly between both groups. After NAC, the disease control rate of the SOX group (94.8%) was comparable with that of the PTXS group (92.3%) (p = 0.641). Twenty-three cases (29.9%) in the SOX group and 10 cases (38.5%) in the PTX group got the descending stage with no statistical difference (p = 0.417). No significant differences were observed in the overall pathological response rate and the overall postoperative complication rate between the two groups (p > 0.05). There were also no differences between groups in terms of 5-year overall and disease-free survival (p > 0.05). CONCLUSIONS: The validity of NAC PTXS was not inferior to that of SOX regimen for locally advanced gastric cancer in terms of treatment response and overall survival. PTXS regimen could be expected to be ideal neoadjuvant chemotherapy for patients with LAGC and should be adopted for the test arm of a large randomized controlled trial.

Effect of lateral lymph nodes without malignant characteristics on the prognosis of patients with rectal cancer.

Background: Lateral lymph node (LLN) metastasis is a poor prognostic factor for rectal cancer patients. However, the effect of LLNs without malignant characteristics on the prognosis of rectal cancer patients has been uncertain. Methods: Consecutive patients who underwent laparoscopic-assisted low anterior resection were included. Patients with MRI-detected LLNs, but without malignant characteristics, were compared with patients with no MRI-detected LLNs. Results: The local recurrence rate was higher in the LLN-present group than in the LLN-absent group (9.8% vs 2.5%; p = 0.056). The overall survival of patients with no MRI-detected LLNs was significantly better than that of patients with MRI-detected LLNs (p = 0.021). Conclusion: The presence of LLNs, even without malignant features, may lead to worse local control and overall survival.

Lymph node metastasis in the pelvic sidewall of patients with rectal cancer is a serious disease that affects the patient's life expectancy. At present, the assessment of lateral lymph node (LLN) metastasis relies mainly on MRI. Currently, there is no consensus on whether small lymph nodes without malignant features detected by MRI affect patient prognosis. Therefore, the authors designed this study to compare the survival of patients with small LLNs detected by MRI with that of patients without LLNs. The authors found that the presence of LLNs, even without malignant features, may lead to worse local control and overall survival. Therefore, for patients with MRI-detected LLNs, LLN dissection should be conducted by experienced surgeons to improve patient prognosis.

Modified π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy: a report of 40 consecutive cases from a single center.

OBJECTIVE: Intracorporeal esophagojejunostomy remains a challenging technique in totally laparoscopic total gastrectomy (TLTG) because of the lack of an established standard anastomosis method. However, π-shaped esophagojejunostomy in TLTG is reportedly safe and feasible. Therefore, we evaluated the short-term surgical outcomes of our modified π-shaped esophagojejunostomy in TLTG. METHODS: This study involved patients without neoadjuvant therapy diagnosed with gastric cancer who underwent TLTG by the same surgeon with modified π-shaped esophagojejunostomy from April 2018 to October 2019. Clinicopathologic data were collected and retrospectively analyzed. RESULTS: Forty patients diagnosed with gastric cancer were included. The mean operative time and estimated blood loss were 264.6 ± 56.9 minutes and 68.5 ± 53.3 mL, respectively. Postoperative flatus occurred at 4.6 ± 1.7 days. The mean time to resumption of diet was 7.4 ± 1.7 days postoperatively. One patient was diagnosed with anastomotic leakage and managed with conservative therapy. Pleural effusion was the most common complication, occurring in four (10%) patients. One patient developed intra-abdominal bleeding that required reoperation. Other complications were atrial fibrillation and wound infection. No mortality occurred during the 6-month follow-up. CONCLUSIONS: Modified π-shaped esophagojejunostomy is safe and feasible for intracorporeal anastomosis in TLTG and showed favorable surgical outcomes in this study.

Effect of the transanal drainage tube on preventing anastomotic leakage after laparoscopic surgery for rectal cancer: a systematic review and meta-analysis.

PURPOSE: Anastomotic leakage (AL) is a common postoperative complication of rectal cancer, and transanal drainage tube (TDT) efficacy is still contentious. This study aimed to evaluate the TDT effect on AL prevention. METHODS: All relevant papers were searched by using a predefined search strategy (two randomized controlled trials (RCTs), one prospective study, and four retrospective studies). Meta-analysis was conducted to estimate AL and re-operation pooled rates. RESULTS: A total of 7 studies (1556 patients) were included: No significant statistic difference was found between two groups on AL rate (odds ratio (OR) 0.61, P = 0.11) and re-operation rate (OR 0.52, P = 0.10). For subgroup analysis, significant statistic difference was found between two groups on AL rate (OR 0.29, P = 0.002) and re-operation rate (OR 0.15, P = 0.04) in patients without neoadjuvant therapy. As for patients without diverting stoma, the AL rate (OR 0.35, P = 0.002) was significantly lower than that in patients without TDT. CONCLUSIONS: TDT may reduce AL morbidity and re-operation rate for patients without high risk of AL, but may be useless for those in high-risk situations.

Health-Related Quality of Life in Patients With Locally Advanced Gastric Cancer Undergoing Perioperative or Postoperative Adjuvant S-1 Plus Oxaliplatin With D2 Gastrectomy: A Propensity Score-Matched Cohort Study.

Background: Some high-quality clinical trials have proven the efficacy and safety of perioperative and postoperative S-1 with oxaliplatin (peri-SOX and post-SOX) for patients with locally advanced gastric cancer (LAGC) undergoing D2 gastrectomy. However, little is known about how health-related quality of life (HRQOL) changes over time in patients receiving peri-SOX or post-SOX chemotherapy. Methods: A prospective observational cohort (NCT04408859) identified 151 eligible patients with LAGC who underwent D2 gastrectomy with at least six cycles of peri-SOX or post-SOX chemotherapy from 2018 to 2020. HRQOL was assessed using the EROTC QLQ-C30 and its gastric module, QLQ-STO22, at indicated measurements, including the baseline, 1st, 3rd, 6th and 12th month after initiation of therapy. Baseline characteristics, therapeutic effects, and longitudinal HRQOL were compared between the peri-SOX and post-SOX groups after propensity score matching. HRQOL changes over time and the risk factors for scales with severe deterioration were further analyzed. Results: No statistically significant differences in longitudinal HRQOL were observed between patients in the peri-SOX and post-SOX groups, with comparable surgical outcomes and adverse chemotherapy events. Scales of social functioning, abnormal taste, and anxiety improved earlier in the peri-SOX group than in the post-SOX group. Score changes in both groups indicated that general deterioration and slower recovery usually occurred in the scales of physical, social, and role functioning, as well as symptoms of fatigue, reflux, diarrhea, and anxiety. Conclusion: Peri-SOX showed a longitudinal HRQOL comparable to post-SOX in patients with LAGC who underwent D2 gastrectomy. The peri-SOX group had better performance in social functioning, abnormal taste, and anxiety at some measurements.

Dynamical analysis of a stochastic delayed SIR epidemic model with vertical transmission and vaccination.

In order to describe the dynamic process of epidemic transmission with vertical transmission and vaccination in more detail and to better track the factors that lead to the occurrence of epidemics, we construct a stochastic delayed model with a specific functional response to describe its epidemic dynamics. We first prove the existence and uniqueness of the positive solution of the model. Moreover, we analyze the sufficient conditions for the extinction and persistence of the model. Finally, numerical simulations are presented to illustrate our mathematical findings.

Bifurcation analysis and optimal control of SEIR epidemic model with saturated treatment function on the network.

In order to study the impact of limited medical resources and population heterogeneity on disease transmission, a SEIR model based on a complex network with saturation processing function is proposed. This paper first proved that a backward bifurcation occurs under certain conditions, which means that R0<1 is not enough to eradicate this disease from the population. However, if the direction is positive, we find that within a certain parameter range, there may be multiple equilibrium points near R0=1. Secondly, the influence of population heterogeneity on virus transmission is analyzed, and the optimal control theory is used to further study the time-varying control of the disease. Finally, numerical simulations verify the stability of the system and the effectiveness of the optimal control strategy.

Neutrophil-to-Lymphocyte Ratio as an Early Predictor of Symptomatic Anastomotic Leakage in Patients after Rectal Cancer Surgery: A Propensity Score-Matched Analysis.

Background: This study aimed to explore the role of postoperative neutrophil-to-lymphocyte ratio in predicting symptomatic anastomotic leakage in patients who underwent laparoscopic low anterior resection for rectal cancer. Methods: In this retrospective cohort study, we analyzed data of patients who underwent laparoscopic low anterior resection from May 2009 to May 2019. A receiver operating characteristic curve analysis was performed to evaluate the cut-off values with the best predictive efficacy of a symptomatic anastomotic leakage. In addition, a propensity score-matched analysis was performed by considering all covariate variables, and 61 patients with or without symptomatic anastomotic leakage were included in the analysis. Results: The present study included 306 patients; of these, 17 (5.56%) developed symptomatic anastomotic leakage after surgery. On postoperative day 5, compared with patients without symptomatic anastomotic leakage, those with leakage had significantly higher neutrophil-to-lymphocyte levels. Notably, a neutrophil-to-lymphocyte cut-off score of 6.54 indicated the best area under the curve of 0.818 (95% confidence interval: 0.697−0.940, p < 0.001) in predicting symptomatic anastomotic leakage, with a sensitivity and specificity of 76.5% and 79.4%, respectively. Conclusions: Although evidence for the predictive role of neutrophil-to-lymphocyte ratio is accumulating, it remains inconclusive. In addition, neutrophil-to-lymphocyte levels should be considered a predictive biomarker for symptomatic anastomotic leakage; however, it can more accurately be viewed as an adjunct that helps increase the clinical suspicion of emerging symptomatic anastomotic leakage.

Study on an SIHRS Model of COVID-19 Pandemic With Impulse and Time Delay Under Media Coverage.

Media coverage plays an important role in prevention and control the spread of COVID-19 during the pandemic. In this paper, an SIHRS model of COVID-19 pandemic with impulse and time delay under media coverage is established. The positive and negative emotions of public are considered by the impact of confirmed cases and medical resources. In order to restrain the negative information of public, the factor of policies and regulations with impulse and time delay is introduced. Furthermore, the system model is simulated and verified by the reported data of COVID-19 pandemic in Wuhan. The main results are as follows: (1) When the implementation rate of the negative information generated by the confirmed cases gradually reduced to 0.4 times, the cumulative confirmed cases will be significantly reduced to about 37000, indicating that the popularization of pandemic related media information should be broad; (2) When the implementation rate affected by the amount of policies and regulations information gradually increases to 3 times, the cumulative confirmed cases will be significantly reduced to about 28000, indicating that the policies and regulations information should be continuously and incrementally reported; (3) When the inhibition rate of policies and regulation information on negative information gradually increases to 3 times, the cumulative confirmed cases will also be significantly reduced to about 27000 cases, indicating that the targeted policies and regulations information has a significant impact on inhibiting the corresponding negative emotions.

Comparison of neoadjuvant chemotherapy followed by surgery vs. surgery alone for locally advanced gastric cancer: a meta-analysis.

BACKGROUND: The neoadjuvant chemotherapy is increasingly used in advanced gastric cancer, but the effects on safety and survival are still controversial. The objective of this meta-analysis was to compare the overall survival and short-term surgical outcomes between neoadjuvant chemotherapy followed by surgery (NACS) and surgery alone (SA) for locally advanced gastric cancer. METHODS: Databases (PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar) were explored for relative studies from January 2000 to January 2021. The quality of randomized controlled trials and cohort studies was evaluated using the modified Jadad scoring system and the Newcastle-Ottawa scale, respectively. The Review Manager software (version 5.3) was used to perform this meta-analysis. The overall survival was evaluated as the primary outcome, while perioperative indicators and post-operative complications were evaluated as the secondary outcomes. RESULTS: Twenty studies, including 1420 NACS cases and 1942 SA cases, were enrolled. The results showed that there were no significant differences in overall survival (P = 0.240), harvested lymph nodes (P = 0.200), total complications (P = 0.080), and 30-day post-operative mortality (P = 0.490) between the NACS and SA groups. However, the NACS group was associated with a longer operation time (P < 0.0001), a higher R0 resection rate (P = 0.003), less reoperation (P = 0.030), and less anastomotic leakage (P = 0.007) compared with SA group. CONCLUSIONS: Compared with SA, NACS was considered safe and feasible for improved R0 resection rate as well as decreased reoperation and anastomotic leakage. While unbenefited overall survival indicated a less important effect of NACS on long-term oncological outcomes.