Patient experience in the implementation of enhanced recovery after surgery strategy after radical gastric cancer surgery / 中华胃肠外科杂志

Objective: To investigate the experience of patients in the implementation of enhanced recovery after surgery (ERAS) strategy after radical gastrectomy and the factors affecting the treatment experience. Methods: A prospective cohort study was carried out. Patients who were diagnosed with gastric cancer by pathology and underwent radical gastrectomy at the Xijing Digestive Disease Hospital from December 2019 to December 2020 were consecutively enrolled. Those who received emergency surgery, residual gastric cancer surgery, preoperative neoadjuvant chemotherapy, non-curative tumor resection, intraperitoneal metastasis, or other malignant tumors were excluded. Patients' expectation and experience during implementation were investigated by questionnaires. The questionnaire included three main parts: patients' expectation for ERAS, patients' experience during the ERAS implementation, and patients' outcomes within 30 days after discharge. The items on the expectation and experience were ranked from 0 to 10 by patients, which indicated to be unsatisfied/unimportant and satisfied/important respectively. According to their attitudes towards the ERAS strategy, patients were divided into the support group and the reject group. Patients' expectation and experience of hospital stay, and the clinical outcomes within 30 days after discharge were compared between the two groups. Categorical data were reported as number with percentage and the quantitative data were reported as mean with standard deviation, or where appropriate, as the median with interquartile range (Q1, Q3). Categorical data were compared using the Chi-squared test or Fisher's exact test, where appropriate. For continuous data, Student's t test or Mann-Whitney U test were used. Complication was classified according to Clavien-Dindo classification. Results: Of the included 112 patients (88 males and 24 females), aged (57.8±10.0) years, 35 patients (31.3%) were in the support group and 77 (68.7%) in the reject group. Anxiety was detected in 56.2% (63/112) of the patients with score >8. The admission education during the ERAS implementation improved the patients' cognitions of the ERAS strategy [M(Q1, Q3) score: 8 (4, 10) vs. 2 (0, 5), Z=-7.130, P<0.001]. The expected hospital stay of patients was longer than the actual stay [7 (7, 10) days vs. 6 (6, 7) days, Z=-4.800, P<0.001]. During the ERAS implementation, patients had low score in early mobilization [3 (1, 6)] and early oral intake [5 (2.25, 8)]. Fifty-eight (51.8%) patients planned the ERAS implementation at home after discharge, while 32.1% (36/112) preferred to stay in hospital until they felt totally recovered. Compared with the reject group, the support group had shorter expected hospital stay [7 (6, 10) days vs. 10 (7, 15) days, Z=-2.607, P=0.009], and higher expected recovery-efficiency score [9 (8, 10) vs. 7(5, 9), Z=-3.078, P=0.002], lower expected less-pain score [8 (6, 10) vs. 6 (5, 9) days, Z=-1.996, P=0.046], expected faster recovery of physical strength score [8 (6, 10) vs. 6 (4, 9), Z=-2.200, P=0.028] and expected less drainage tube score [8 (8, 10) vs. 8 (5, 10), Z=-2.075, P=0.038]. Worrying about complications (49.1%) and self-recognition of not recovery (46.4%) were the major concerns when assessing the experience toward ERAS. During the follow-up, 105 patients received follow-up calls. There were 57.1% (60/105) of patients who experienced a variety of discomforts after discharge, including pain (28.6%), bloating (20.0%), nausea (12.4%), fatigue (7.6%), and fever (2.9%). Within 30 days after discharge, 6.7% (7/105) of patients developed Clavien-Dindo level I and II operation-associated complications, including poor wound healing, intestinal obstruction, intraperitoneal bleeding, and wound infection, all of which were cured by conservative treatment. There were no complications of level III or above in the whole group after surgery. Compared with the support group, more patients in the reject group reported that they had not yet achieved self-expected recovery when discharged [57.1% (44/77) vs. 22.9% (8/35), χ2=11.372, P<0.001], and expected to return to their daily lives [39.0% (30/77) vs. 8.6% (3/35), χ2=10.693, P<0.001], with statistically significant differences (all P<0.05). Only 52.4% (55/105) of patients returned home to continue rehabilitation, and the remaining patients chose to go to other hospitals to continue their hospitalization after discharge, with a median length of stay of 7 (7, 9) days. Compared with the reject group, the support group had a higher proportion of home rehabilitation [59.7% (12/33) vs. 36.4% (43/72), χ2=4.950, P=0.026], and shorter time of self-perceived postoperative full recovery [14 (10, 20) days vs. 15 (14, 20) days, Z=2.100, P=0.036], with statistically significant differences (all P<0.05). Conclusions: Although ERAS has promoted postoperative rehabilitation while ensuring surgical safety, it has not been unanimously recognized by patients. Adequate rehabilitation education, good analgesia, good physical recovery, and early removal of drainage tubes may improve the patient's experience of ERAS.

Inter-hemispheric Functional Connections Are More Vulnerable to Attack Than Structural Connection in Patients With Irritable Bowel Syndrome

Background/Aims@#Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disease characterized by recurrent abdominal pain and bowel dysfunction. However, the majority of previous neuroimaging studies focus on brain structure and connections but seldom on the inter-hemispheric connectivity or structural asymmetry. This study uses multi-modal imaging to investigate the abnormal changes across the 2 cerebral hemispheres in patients with IBS. @*Methods@#Structural MRI, resting-state functional MRI, and diffusion tensor imaging were acquired from 34 patients with IBS and 33 healthy controls. The voxel-mirrored homotopic connectivity, fractional anisotropy, fiber length, fiber number, and asymmetry index were calculated and assessed for group differences. In addition, we assessed their relevance for the severity of IBS. @*Results@#Compared with healthy controls, the inter-hemispheric functional connectivity of patients with IBS showed higher levels in bilateral superior occipital gyrus, middle occipital gyrus, precuneus, posterior cingulate gyrus, and angular gyrus, but lower in supplementary motor area. The statistical results showed no significant difference in inter-hemispheric anatomical connections and structural asymmetry, however negative correlations between inter-hemispheric connectivity and the severity of IBS were found in some regions with significant difference. @*Conclusions@#The functional connections between cerebral hemispheres were more susceptible to IBS than anatomical connections, and brain structure is relatively stable. Besides, the brain areas affected by IBS were concentrated in default mode network and sensorimotor network.

Target gene panel method versus whole-exome sequencing in detection of idiopathic hypogonadotropic hypogonadism in males / 中华男科学杂志

Objective@#To compare the efficiency of the target gene panel method and whole-exome sequencing (WES) in detecting idiopathic hypogonadotropic hypogonadism (IHH), and select a more suitable gene detection method.@*METHODS@#We selected 24 genes closely related to the molecular pathogenesis of IHH to make up the gene panel, detected the mutation sites in 73 patients with IHH using the panel method, and verified the results of sequencing with the Sanger method. Using the key words "idiopathic hypogonadotropic hypogonadism", we searched databases for relevant literature, calculated the positive rate of IHH detected by WES and compared it with that detected with the panel method.@*RESULTS@#Of the 73 cases of IHH detected with the panel method, 7 were found with pathogenic mutations, including 2 cases of FGFR1, 2 cases of CHD7, 2 cases of KISS1R, and 1 case of NR5A1 mutation. Sanger sequencing showed that the positive rate of the panel method was 9.7%. Of the 1 336 articles retrieved, 5 met the inclusion criteria and were included, in which WES revealed a positive rate of about 30%.@*CONCLUSIONS@#For detection of the diseases with clear mutated genes, the panel method is relatively inexpensive and has a high sequencing depth, while for detection of the diseases with complicated genetic patterns and unclear mutated genes, WES is more efficient. Further studies are needed for choice of the two methods for different purpose of detection./.

Inter-hemispheric Functional Connections Are More Vulnerable to Attack Than Structural Connection in Patients With Irritable Bowel Syndrome

Background/Aims@#Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disease characterized by recurrent abdominal pain and bowel dysfunction. However, the majority of previous neuroimaging studies focus on brain structure and connections but seldom on the inter-hemispheric connectivity or structural asymmetry. This study uses multi-modal imaging to investigate the abnormal changes across the 2 cerebral hemispheres in patients with IBS. @*Methods@#Structural MRI, resting-state functional MRI, and diffusion tensor imaging were acquired from 34 patients with IBS and 33 healthy controls. The voxel-mirrored homotopic connectivity, fractional anisotropy, fiber length, fiber number, and asymmetry index were calculated and assessed for group differences. In addition, we assessed their relevance for the severity of IBS. @*Results@#Compared with healthy controls, the inter-hemispheric functional connectivity of patients with IBS showed higher levels in bilateral superior occipital gyrus, middle occipital gyrus, precuneus, posterior cingulate gyrus, and angular gyrus, but lower in supplementary motor area. The statistical results showed no significant difference in inter-hemispheric anatomical connections and structural asymmetry, however negative correlations between inter-hemispheric connectivity and the severity of IBS were found in some regions with significant difference. @*Conclusions@#The functional connections between cerebral hemispheres were more susceptible to IBS than anatomical connections, and brain structure is relatively stable. Besides, the brain areas affected by IBS were concentrated in default mode network and sensorimotor network.

Associations of neglect and physical abuse with non-suicidal self-injury behaviors among adolescents in rural China / 中国学校卫生

Objective@#To investigate the relationship between neglect , physical abuse and non-suicidal self-injury (NSSI) behaviors among middle school students in rural China.@*Methods@#A total of 14 162 adolescents in Anhui, Guangdong, Yunnan, Heilongjiang and Hubei provinces were selected by multi-stage cluster random sampling method. Data were obtained on demographic information, neglect, physical abuse and non-suicidal self-injury from questionnaire survey.@*Results@#During the past year before survey, 13.5% of participants engaged in self-injury 5 times or more, 15.4% of participants engaged in self-injury 1 to 4 times. Both neglect and physical abuse were significantly associated with self-injury in adolescents(P<0.01). After adjusted for gender, ethnicity, the only-one child, family structure, family economic status, and other variables, multinomial logistic regression showed that neglect and physical abuse were positively associated with self-injury behavior(OR=1.43-3.23). There was a potential dose-response relationship of accumulating physical abuse types and self-injury, with more physical abuse types, the higher risk of self-injury behavior.@*Conclusion@#Neglect and physical abuse experience should be considered as a risk factor for NSSI among adolescents in rural China. Specific intervention targeting neglect and physical abuse should be strengthened to reduce the occurrence of NSSI.

Association of non-suicidal self-injury with Internet addictive behavior among adolescents / 中国学校卫生

Objective@#To explore the relationship between non-suicidal self-injury and Internet addictive behavior in adolescents.@*Methods@#A cross-sectional survey of 15 538 middle school students across 5 provinces in China. Participants reported self- injury behavior during the past year and the Internet addition behaviors were assessed through Young’s Internet Addiction Test(IAT).@*Results@#The prevalence of self-reported 1-year NSSI, Internet addictive behavior and pre-addictive behaviors was 28.7%, 3.3% and 29.9%, respectively. After controlling for potential confounders, the Internet addition was positively correlated with NSSI, and the risk of all types of NSSI was higher in adolescent with Internet addition than those with mild suspected Internet addictive behavior(OR=1.3-2.8).@*Conclusion@#These findings indicate that Internet addition is associated with the incidence of NSSI in adolescents.

Relationships among attitude to death, work engagement and organizational citizenship behaviors in emergency nurses / 中国实用护理杂志

Objective@#To investigate the attitude to death, work engagement and organizational citizenship behaviors (OCB) in emergency nurses, and to analyze the relationships among them.@*Methods@#Two hundred and fifty-one emergency nurses were investigated with Chinese version of Death Attitude Profile-Revised (DAP-R), the Medical Personnels Work Engagement questionnaire and Medical Staffs, Organizational Citizenship Behavior questionnaire.@*Results@#The attitude to death in emergency nurses was relatively positive and the total score of DAP-R was 103.49±14.76.There were significant differences on the score of nursing ages, emergency working years and religious beliefs (F=4.584, 6.159, 5.251, P<0.01). The neutral acceptance to death was positively correlated with the work engagement (r=0.098, P<0.01) , the work engagement was negatively correlated with death avoidance (r=-0.177, P<0.01) .The neutral acceptance to death was positively correlated with the OCB, civic responsibility and responsible behavior (r=0.155, 0.161, 0.202, P<0.05 or 0.01).@*Conclusion@#The attitude to death has significant influence on work engagement and OCB in emergency nurses. Nursing administrators should through establishing an effective strategies to improve the positive attitude to death and OCB level. Ultimately, give full play to the role of the emergency department nurse in terminal care and quality of emergency medical care can be improved.

Meta-analysis of SGLT2 inhibitors and stroke risk in type 2 diabetic patients / 中华内分泌代谢杂志

Objective To evaluate the effects of sodium-glucose cotransporter 2 ( SGLT2) inhibitors on the stroke risk for patients with type 2 diabetes mellitus (T2DM). Methods A systemic meta-analysis including 30 random control trails ( RCTs) was performed to compare the risk of stroke between type 2 diabetic patients treated with SGLT2 inhibitors and control drugs. Then their bias risk and quality were assessed and meta-analysis was conducted using Stata12.0 software. Results Thirty RCTs enrolling 74456 participants were selected for meta-analysis. The stroke incidence in the group receiving SGLT2 inhibitor monotherapy or combination therapy did not significantly differ from that in control group, with relative risk (RR) 1.01 (95％CI 0.93-1.10, P=0.978) and 1.00 (95％CI 0.92-1.09, P=0. 874 ) , respectively. Three SGLT2 inhibitors canagliflozin, dapagliflozin, and empagliflozin did not increase the risk of stroke, with similar RR values ( RR=0.91, 0.99, 1.13, respectively) . Subgroup analyses showed that there was no correlation between SGLT2 inhibitors and stroke risk in different gender, age, diabetes duration, body mass index, or HbA1C levels. Conclusions Whether administered as monotherapy or add-on therapy, SGLT2 inhibitors did not increase stroke incidence, and there were no significant within-class differences.

Analysis of risk factors and prognosis of esophagojejunal anastomotic leakage in gastric cancer patients after curative total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To identify the risk factors of esophagojejunal anastomotic leakage (EJAL) and its impact on prognosis of gastric cancer patients after curative total gastrectomy.</p><p><b>METHODS</b>Clinical and follow-up data of 1254 gastric cancer patients who underwent radical total gastrectomy at the Department of Digestive Surgery, Xijing Hospital, from January 2012 to May 2015 were retrospectively collected. Risk factors of EJAL and prognostic factors of patients were analyzed respectively. In order to reduce the influences of other prognostic factors on survival, patients with and without EJAL were selected using Gmatch methods based on the results of prognostic factor analysis. Survival of those with or without EJAL was examined before and after match respectively.</p><p><b>RESULTS</b>EJAL occurred in 31 of 1 254 patients(2.5%). The leakage was diagnosed at a median of 6 (range, 4-12) days after surgery. Multivariate analysis demonstrated that preoperative low serum albumin(<35 g/L)(P=0.018), pulmonary insufficiency(P=0.006), long duration of operation(≥240 min)(P=0.001) were independent risk factors of EJAL. All the patients were followed up for 3-40(median 18) months. Multivariate analysis showed that age(≥65, P=0.000), intraoperative blood transfusion (P=0.016), EJAL (P=0.000), tumor location (distal, P=0.020; total, P=0.001), depth of invasion (T4, P=0.005) and lymph node metastasis (N2, P=0.002, N3, P=0.000) were prognostic predictors. Twenty-six patients with EJAL were successfully matched to 104 patients without EJAL in a ratio of 1/4 ratio. Patients with EJAL had a significantly worse overall 3-year survival rate than those without (44.3% vs. 66.7%, P=0.002).</p><p><b>CONCLUSIONS</b>EJAL after curative total gastrectomy leads to worse survival. Patients with preoperative low serum albumin, pulmonary insufficiency and long duration of operation should be taken care of during perioperative period to prevent the occurrence of EJAL.</p>

Comparison of long-term survival and postoperative complications between Billroth I( and II( reconstruction in patients with distal gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the long-term survival and postoperative complications of distal gastric cancer patients between Billroth I((BI() and Billroth II((BII() reconstruction.</p><p><b>METHODS</b>Clinicopathological data of 992 patients with distal gastric cancer who underwent D2 curative gastrectomy in our department from May 2008 to April 2015 were recorded, including 207 patients of BI( reconstruction and 785 of BII( reconstruction, were retrospectively analyzed. Patients presenting a previous history of cancer, gastric resection or cytotoxic chemotherapy, and those presenting liver or intraperitoneal tumor dissemination or unresectable infiltration into contiguous organs were excluded. Patients in BI( and BII( group were selected using gmatch methods based on age (±10 years), gender, tumor size (±1 cm), differentiated degree and depth of invasion in order to reduce the selection bias of clinicopathological characteristics. The final number of patients matched was 191 respectively.</p><p><b>RESULTS</b>Compared with BII( group, the BI( group had a significantly shorter operation time (181.7 min vs. 220.7 min, P=0.000) and a shorter postoperative hospitalization stay (7.6 days vs. 8.1 days, P=0.046). The postoperative complications including anastomotic leakage, wound dehiscence, wound infection, intraperitoneal hemorrhage, intestinal obstruction, duodenal stump fistula, pulmonary infection and fever had no significant difference(P>0.05). Three-year survival between two groups was comparable (82.9% vs. 78.7%, P=0.379).</p><p><b>CONCLUSIONS</b>Compared with BII(, BI( reconstruction is more suitable for patients with distal gastric cancer.</p>

Impact of cytoreductive surgery on survival in gastric cancer patients with peritoneal metastasis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the survival benefit of cytoreductive surgery in gastric cancer patients with peritoneal metastasis.</p><p><b>METHODS</b>Clinicopathological data of 151 advanced gastric adenocarcinoma patients with extensive peritoneal metastasis who were identified by surgical exploration between May 2008 and April 2015 in Xijing Hospital of Digestive Diseases were analyzed retrospectively. Of all the patients, 32 cases were treated by cytoreductive surgery with local radical tumor resection and regional lymph node cleaning, combined with fluorouracil-based adjuvant chemotherapy after surgery (cytoreductive surgery combined with chemotherapy group); 39 caseswere only treated by cytoreductive surgery group(cytoreductive surgery group);23 caseswere treated bysurgical exploration combined with fluorouracil-based adjuvant chemotherapy after surgery(surgical exploration combined with chemotherapy group) and 57 cases were only treated bysurgical exploration (surgical exploration group). The overall survival of four groups were analyzed and compared.</p><p><b>RESULTS</b>Among the 151 patients, 148 (98.0%) patients were followed up. The median follow up time was 7.2 months (range 1.4-61.2). The median survival of cytoreductive surgery combined with chemotherapy group, cytoreductive surgery group, surgical exploration combined with chemotherapy group and surgical exploration group was 11.9(95% CI: 8.8-15.1) months, 7.1(95% CI: 3.2-11.1) months, 8.2(95% CI:4.6-11.8) and 5.4(95% CI:4.4-6.4) months, respectively(P < 0.01).</p><p><b>CONCLUSIONS</b>Cytoreductive surgery can prolong the survival of gastric adenocarcinoma patients with extensive peritoneal metastasis. Cytoreductive surgery combined with chemotherapy may provide more benefit for patients, and can be used as a choice of treatment in these patients.</p>

Survival rate of proximal and total gastrectomy in treatment of esophagogastric junction adenocarcinoma (Siewert II( Types) / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the survival rate of proximal gastrectomy and total gastrectomy in the treatment of esophagogastric junction (EGJ) adenocarcinoma (Siewert II( types), and to provide reference for clinical choice.</p><p><b>METHODS</b>A total of 533 patients with Siewet II( type EGJ adenocarcinoma were screened. All the patients underwent radical operations and were pathologically diagnosed as Siewet II( type EGJ adenocarcinoma in Xijing Hospital of Digestive Diseases from May 2008 to March 2014. These patients all had complete followed-up data. Finally, 234 patients were enrolled into the retrospective study, and divided into proximal gastrectomy group(117 patients) and total gastrectomy group (117 patients) based on the matching of age, sex, tumor size, TNM staging, and differentiation. The survival rate was compared between the two groups.</p><p><b>RESULTS</b>In proximal gastrectomy and total gastrectomy group, the overall 3-year survival rate was 65.6% and 62.6% respectively, and the overall 5-year survival rate was 53.8% and 44.5% respectively. No significant difference was found between the two groups (P=0.768). In subgroup analyses of 3-year survival rate between proximal gastrectomy group and total gastrectomy group, the results were as follows: 72.8% and 80.4% respectively (P=0.423) for tumor diameter ≤4 cm, 57.9% and 46.5% (P=0.239) for tumor diameter >4 cm, 83.3% and 83.3% (P=0.998) for high differentiated EGJ adenocarcinoma, 68.2% and 53.3% (P=0.270) for moderate differentiated EGJ adenocarcinoma, 56.1% and 69.6% (P=0.280) for poorly differentiated EGJ adenocarcinoma, 64.8% and 56.0% (P=0.451) for mucinous EGJ adenocarcinoma, 80.0% and 76.9% (P=0.912) for T1-2 stage EGJ adenocarcinoma, 64.3% and 60.4% (P=0.610) for T3 stage, 50.0% and 62.5% (P=0.953) for T4a stage, 92.3% and 100% (P=0.380) for stage I( EGJ adenocarcinoma, 79.6% and 66.3%(P=0.172) for stage II(, 42.6% and 49.5% (P=0.626) for stage I I(. All above differences between the two groups were not significant(all P>0.05).</p><p><b>CONCLUSION</b>Proximal gastrectomy and total gastrectomy are comparable in terms of 3-year and 5-year survival rates.</p>

Work engagement and its influencing factors in emergency nurses / 中国实用护理杂志

Objective To investigate the current status and influencing factors of work engagement in emergency nurses, put forward a feasible strategy, improve the emergency department nurses work engagement for the emergency department to build effective human resource management to provide the reference. Methods A total 226 emergency nurses from 8 hospital of first-class in Tianjin city were recruited by the convenience sampling method and investigated with a self designed, the Medical Personnel′s Work Engagement Questionnaire. Results The total score of Medical Personnel′s Work Engagement Questionnaire was 111-166(137.32 ± 12.48) points and the scores were the highest in interpersonal concordance (4.20 ± 0.46) points and the lowest in work vigor (3.01 ± 0.61) points. Variance analysis and multiple linear regression analysis showed that gender, employment category and number of years as an emergency nurses were the influencing factors of work engagement, which could explain 51.3%of the variance. Conclusions Work engagement emergency of nurses is at a relatively moderate-to-high level, through establishing an effective incentive mechanism, increasing social benefits, accelerating the construction of emergency specialist nurse training system and paying attention to occupational development, work engagement level and quality of emergency medical care can be improved.

Study on prognosis relationship between ABO blood groups of patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the relationship of ABO blood group with the clinicopathological characteristics in patients with gastric cancer and to assess whether the ABO blood group was associated with prognosis.</p><p><b>METHOD</b>Clinicopathological and follow-up data of 2838 patients with gastric cancer who underwent radical gastrectomy in our department from June 2008 to October 2013 were analyzed retrospectively. The distribution of ABO blood group under different clinicopathological characteristics and the overall 5-year survival of ABO blood group were compared.</p><p><b>RESULTS</b>There were no significant differences in clinicopathological characteristics among patients with different ABO blood groups (all P>0.05). The 5-year overall survival(OS) rates were 57.3% for patients with blood type A, 54.7% for type B, 57.4% for type O, and 53.5% for type AB. Though there was no significance difference of survival among ABO blood groups(P=0.722), while the subgroup analysis indicated that stage III( patients of blood group Non-AB had a poorer OS compared to those of blood group AB(25.2% vs. 44.7%, P=0.014); smoking patients of blood group Non-AB had a poorer OS compared to those of blood group AB(53.4% vs. 74.9%, P=0.044).</p><p><b>CONCLUSION</b>Neither clinicopathological characteristics nor overall survival are associated with the ABO blood group, however, stage III( and smoking patients of blood group Non-AB have a poorer OS compared to those of blood group AB.</p>

Distal gastrectomy brings a better long-term survival for patients with distal gastric cancer compared with total gastrectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the long-term survival and the postoperative complication morbidity of distal gastric cancer patients between distal gastrectomy (DG) and total gastrectomy (TG).</p><p><b>METHODS</b>Clinicopathological data of 1140 patients with distal gastric cancer undergoing curative gastrectomy from May 2008 to April 2015 were analyzed retrospectively. A total of 992 patients underwent DG (207 patients of Billroth I( and 785 of Billroth II() and 148 patients underwent TG. Patients between the DG and TG group were selected using gmatch methods based on tumor size(±1 cm), differentiated degree and depth of invasion in order to reduce the differences in clinicopathological characteristics.</p><p><b>RESULTS</b>Compared with TG group, the DG group had significantly shorter operation time (198.8 min vs. 236.0 min, P=0.001), less blood loss (197.1 ml vs. 252.8 ml, P=0.033), and shorter postoperative hospital stay (7.8 days vs. 8.5 days, P=0.036). However, the postoperative complication morbidity and mortality were not significantly different between the two groups (P>0.05). The 3-year survival rate was significantly higher in the DG group compared to the TG group (74.4% vs. 58.7%, P=0.013).</p><p><b>CONCLUSIONS</b>Compared with TG, DG has a comparable safety and a better long-term survival. DG should be considered as the optimal choice for patients with distal gastric cancer.</p>

Preparation and in vitro evaluation of borneol and folic acid co-modified doxorubicin loaded PAMAM drug delivery system / 药学学报

A novel targeting drug carrier (FA-BO-PAMAM) based on the PAMAM G5 dendrimer modified with borneol (BO) and folic acid (FA) molecules on the periphery and doxorubicin (DOX) loaded in the interior was designed and prepared to achieve the purposes of enhancing the blood-brain barrier (BBB) transportation and improving the drug accumulation in the glioma cells. 1H NMR was used to confirm the synthesis of FA-BO-PAMAM; its morphology and mean size were analyzed by dynamic light scattering (DLS) and transmission electron microscope (TEM). Based on the HBMEC and C6 cells, cytotoxicity assay, transport across the BBB, cellular uptake and anti-tumor activity in vitro were investigated to evaluate the properties of nanocarriers in vitro. The results showed that the nanocarrier of FA-BO-PAMAM was successfully synthesized, which was spherical in morphology with the average size of (22.28 ± 0.42) nm, and zeta potential of (7.6 ± 0.89) mV. Cytotoxicity and transport across the BBB assay showed that BO-modified conjugates decreased the cytotoxicity of PAMAM against both HBMEC and C6 cells and exhibited higher BBB transportation ability than BO-unmodified conjugates; moreover, modification with FA increased the total uptake of DOX by C6 cells and enhanced the cytotoxicity of DOX-polymer against C6 cells. Therefore, FA-BO-PAMAM is a promising nanodrug delivery system in employing PAMAM as a drug carrier and treatment for brain glioma.

Preparation and in vitro/in vivo evaluation of arsenic trioxide-loaded pH-responsive mesoporous silica nanoparticles / 中草药

Objective: To prepare polyacrylic acid grafted arsenic trioxide-loaded pH-responsive mesoporous silica nanoparticles (PAA-ATO-MSNs) and to investigate their physicochemical properties, in vitro release behavior, and pharmacokinetics in rats. Methods: PAA was covalently attached to the exterior surface of amino group functionalized MSNs prepared by co-condensation method and ATO was loaded into them by electrostatic adsorption. Transmission electron microscope (TEM), small angle X-ray diffraction (SAXRD), nitrogen adsorption, thermogravimetric analysis (TGA), fourier transform infrared (FT-IR) spectra, and laser particle size analyzer were used to determine the physicochemical properties. The entrapment efficiency (EE) and drug loading (DL) of PAA-ATO-MSNs were investigated with the method of high speed centrifugation combined with inductively coupled plasma emission spectrum (ICP). The drug release behavior of PAA-ATO-MSNs was studied using dynamic dialysis method, PBS (pH 5.0, 6.0, and 7.4) chosen as release media. Pharmacokinetic behavior of PAA-ATO-MSNs after iv injection in rats was studied. Results: Morphology of PAA-ATO-MSNs was spherical and the mean particle size, Zeta potential, EE, and DL of PAA-ATO-MSNs were (158.60 ± 1.32) nm, (-28.40 ± 0.34) mV, (40.95 ± 3.21)%, and (11.42 ± 1.75)%, respectively. In vitro release behavior of PAA-ATO-MSNs showed pH-responsive characteristic and the cumulative release amount was increased with the decrease of pH value. Compared with ATO-Sol and ATO-MSNs group, t1/2β was significantly prolonged and AUC was significantly increased (P < 0.01). Conclusion: Release of ATO from PAA-ATO-MSNs showed the obvious pH-responsive characteristic and sustained-release in vitro and PAA-ATO-MSNs could improve the pharmacokinetic behavior in rats. PAA-MSNs might be promising carrier to load ATO for cancer therapy.

Expressions of TLR-2 and TRL-4 in gingival tissues of patients with periodontitis / 上海第二医科大学学报

Objective To detect the distributions and expressions of Toll-like receptor-2(TLR-2)and TLR-4 in different kinds of periodontitis and different extent of the inflammation of gingival tissues and to discuss the roles of TLR-2 and TLR-4 in the progress of periodontal inflammation.Methods Gingival biopsies were divided into 5 groups:control group(n=10),chronic periodontitis group(n=10),chronic periodontitis clinically healthy group(n=10),aggressive periodontitis group(n=10),and aggressive periodontitis clinically healthy group(n=10).The distributions and expressions of TLR-2 and TLR-4 were detected by immunohistochemistry.Results TLR-2 and TLR-4 expressed in all layers of gingival connective tissues.TLR-4 was also observed in gingival epithelium.Compared to control group,expressions of TLR-2 and TLR-4 were significantly higher than those in the other 4 groups(P