Comparison of efficacy between laparoscopic and open proximal gastrectomy with double-tract reconstruction for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction / 中华胃肠外科杂志

Objective: To compare the efficacy between laparoscopic and open proximal gastrectomy with double-tract reconstruction for Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) Siewert II and III AEG was confirmed by preoperative gastroscopy and biopsy, which could not be resected by endoscopy; patients undergoing radical proximal gastrectomy with double-tract reconstruction; (3) contrast-enhanced abdominal CT staging was cT1-2N0M0; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, American Association of Anesthesiologists (ASA) grade 1 to 2; (5) patients agreed to perform proximal gastrectomy and signed an informed consent. Those who had undergone neoadjuvant radiochemotherapy, suffered from serious mental diseases and had incomplete data were excluded. According to the above criteria, clinical data of 84 consecutive patients with Siewert II and III AEG undergoing surgery at General Surgery Department of The Affiliated Tumor Hospital of Zhengzhou University from October 2010 to December 2018 were collected and analyzed. Of 84 patients, 61 underwent open proximal gastrectomy with double-tract reconstruction (OPG group), while 23 underwent laparoscopic proximal gastrectomy with double-tract reconstruction (LPG group). The perioperative complications and postoperative reflux esophagitis of two groups were compared. A P-value of <0.05 was considered to be statistically significant. Results: Among 84 cases, 74 were male and 10 were female. There were 43 cases of Siewert type II and 41 cases of Siewert type III. There were no significant differences in age, gender, body mass index, comorbidities, Siewert type, and tumor staging between the two groups (all P>0.05). As compared to the OPG group, the LPG group had longer operation duration [(223±21) minutes vs. (161±14) minutes, t=15.352, P<0.001], less intraoperative blood loss [195 (150, 215) ml vs. 208 (192, 230) ml, Z=2.143, P=0.032], and shorter time to flatus [(2.8±0.7) days vs. (3.3±0.9) days, t=2.477, P=0.015]. There were no significant differences in the number of harvested lymph nodes, time to the first meal and postoperative hospital stay between the two groups (all P>0.05). Postoperative complications developed in 2 cases (8.7%, 1 case each for anastomotic leakage and intestinal obstruction) in the LPG group and 5 cases (8.2%, 1 case each for anastomotic leakage, anastomotic bleeding, and anastomotic stenosis, 2 cases of incision infection) in the OPG group (χ(2)=5.603, P=0.231). The median follow-up was 41.2 (12.8-110.5) months. One patient (1.6%,1/61) had obvious reflux symptoms in the OPG group, compared with none in the LPG group (χ(2)=0.644, P=0.422). Esophagitis occurred in 1 case (4.8%, 1/21) in LPG group, compared with 4 patients (7.1%, 4/56) in the OPG group, without significant difference between the two groups (χ(2)=0.505, P=0.477). Conclusion: Laparoscopic proximal gastrectomy with double-tract reconstruction is safe and feasible without increasing the risk of postoperative complication and reflux esophagitis.

The effects of influenza-like illness definitions on influenza surveillance in hospitalized children / 中华疾病控制杂志

Objective To evaluate clinical factors associated with laboratory-confirmed influenza infection and probe into the effects of different influenza-like illness(ILI) definitions on influenza surveillance in hospitalized children. Methods The influenza surveillance on the hospitalized children with acute respiratory infection was carried out in Soochow university affiliated children’s hospital from October 2017 to May 2018. The definition of influenza-like illness(ILI), which proposed by world health organization (WHO), the European center for disease prevention and control (ECDC) and ministry of public health of China, was analyzed to determine the area under receiver operating characteristic curve (ROC), sensibility, specificity, and the positive and negative predictive values of the ILI definition using the laboratory evidence of influenza virus infection as golden criteria. Logistic regression model was employed to explore the risk factors of the laboratory confirmed influenza infection among the hospitalized children. Results Of the enrolled 1 459 hospitalized children, 204(14.0%) were lab-confirmed influenza cases. The ECDC definition had the highest sensitivity (91.7%, 95% CI: 87.9%-95.5%) but the lowest specificity (44.6%, 95% CI: 41.9%-47.4%). The WHO definition had the lowest specificity (70.6%, 95% CI: 64.3%-76.8%). China’s definition was the most discriminant definition with relatively high sensitivity (91.2%, 95% CI: 87.3%-95.1%) and specificity (51.5%, 95% CI: 48.8%-54.3%), and its positive area under curve value (71.2%, 95% CI: 67.9%-74.5%) was the highest. Multivariate analysis model showed that the detection rate of influenza virus in children with fever (≥38 ℃) was higher than that in children without fever (OR=7.03, 95% CI:3.89-12.70). Conclusions It is suggested to adopt China’s ILI definition to get better output during influenza surveillance among hospitalized children.