Safety and efficacy of laparoscopic surgery in locally advanced gastric cancer patients with neoadjuvant chemotherapy combined with immunotherapy / 中华胃肠外科杂志

Objective: To investigate the safety and efficacy of laparoscopic surgery in locally advanced gastric cancer patients with neoadjuvant SOX chemotherapy combined with PD-1 inhibitor immunotherapy. Methods: Between November 2020 and April 2021, patients with locally advanced gastric cancer who were admitted to the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology were prospectively enrolled in this study. Inclusion criteria were: (1) patients who signed the informed consent form voluntarily before participating in the study; (2) age ranging from 18 to 75 years; (3) patients staged preoperatively as cT3-4N+M0 by the TNM staging system; (4) Eastern Collaborative Oncology Group score of 0-1; (5) estimated survival of more than 6 months, with the possibility of performing R0 resection for curative purposes; (6) sufficient organ and bone marrow function within 7 days before enrollment; and (7) complete gastric D2 radical surgery. Exclusion criteria were: (1) history of anti-PD-1 or PD-L1 antibody therapy and chemotherapy; (2) treatment with corticosteroids or other immunosuppre- ssants within 14 days before enrollment; (3) active period of autoimmune disease or interstitial pneumonia; (4) history of other malignant tumors; (5) surgery performed within 28 days before enrollment; and (6) allergy to the drug ingredients of the study. Follow-up was conducted by outpatient and telephone methods. During preoperative SOX chemotherapy combined with PD-1 inhibitor immunotherapy, follow-up was conducted every 3 weeks to understand the occurrence of adverse reactions of the patients; follow-up was conducted once after 1 month of surgical treatment to understand the adverse reactions and survival of patients. Observation indicators were: (1) condition of enrolled patients; (2) reassessment after preoperative therapy and operation received (3) postoperative conditions and pathological results. Evaluation criteria were: (1) tumor staged according to the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system; (2) tumor regression grading (TRG) of pathological results were evaluated with reference to AJCC standards; (3) treatment-related adverse reactions were evaluated according to version 5.0 of the Common Terminology Criteria for Adverse Events; (4) tumor response was evaluated by CT before and after treatment with RECIST V1.1 criteria; and (5) Clavien-Dindo complication grading system was used for postoperative complications assessment. Results: A total of 30 eligible patients were included. There were 25 males and 5 females with a median age of 60.5 (35-74) years. The primary tumor was located in the gastroesophageal junction in 12 cases, in the upper stomach in 8, in the middle stomach in 7, and in the lower stomach in 3. The preoperative clinical stage of 30 cases was III. Twenty-one patients experienced adverse reactions during neoadjuvant chemotherapy combined with immunotherapy, including four cases of CTCAE grade 3-4 adverse reactions resulting in bone marrow suppression and thoracic aortic thrombosis. All cases of adverse reactions were alleviated or disappeared after active symptomatic treatment. Among the 30 patients who underwent surgery, the time from chemotherapy combined with immunotherapy to surgery was 28 (23-49) days. All 30 patients underwent laparoscopic radical gastrectomy, of which 20 patients underwent laparoscopic-assisted radical gastric cancer resection; 10 patients underwent total gastrectomy for gastric cancer, combined with splenectomy in 1 case and cholecystectomy in 1 case. The surgery time was (239.9±67.0) min, intraoperative blood loss was 84 (10-400) ml, and the length of the incision was 7 (3-12) cm. The degree of adenocarcinoma was poorly differentiated in 18 cases, moderately differentiated in 12 cases, nerve invasion in 11 cases, and vascular invasion in 6 cases. The number lymph nodes that underwent dissection was 30 (17-58). The first of gas passage, the first postoperative defecation time, the postoperative liquid diet time, and the postoperative hospitalization time of 30 patients was 3 (2-6) d, 3 (2-13) d, 5 (3-12) d, and 10 (7-27) d, respectively. Postoperative complications occurred in 23 of 30 patients, including 7 cases of complications of Clavien-Dindo grade IIIa or above. Six patients improved after treatment and were discharged from hospital, while 1 patient died 27 days after surgery due to granulocyte deficiency, anemia, bilateral lung infection, and respiratory distress syndrome. The remaining 29 patients had no surgery-related morbidity or mortality within 30 days of discharge. Postoperative pathological examination showed TRG grades 0, 1, 2, and 3 in 8, 9, 4, and 9 cases, respectively, and the number of postoperative pathological TNM stages 0, I, II, and III was 8, 7, 8, and 7 cases, respectively. The pCR rate was 25.0% (8/32). Conclusion: Laparoscopic surgery after neoadjuvant SOX chemotherapy combined with PD-1 inhibitor immunotherapy for locally advanced gastric cancer is safe and feasible, with satisfactory short-term efficacy. Early detection and timely treatment of related complications are important.

Prospective-triggered high-pitch spiral versus sequential dual-source CT coronary angiography: comparison of image quality and radiation dose

Background: prospectively electrocardiography [ECG]-triggered high-pitch spiral coronary computed tomography angiography [CCTA] is a unique scan mode for dual -source CT [DSCT]. Our reports aim to compare image quality and radiation dose of CCTA using high-pitch spiral or sequential acquisition mode in patients with low and stable heart rates

Materials and Methods: patients with low and stable heart rates [HR] [HR >/= 70 beats per minute [bpm]; heart rate variability [HRV] < 10 bpm] were randomly assigned to high-pitch spiral mode [group A; n = 80] or sequential acquisition mode [group B; n = 80]. Image quality scores, image noise, effective radiation dose and influencing factors on image quality were assessed

Results: mean image quality scores were 1.51 +/- 0.32 and 1.70 +/- 0.38 for groups A and B [P < 0.05], respectively. Image noises of the two groups were 19.05 +/- 4.70 Hu and 27.21 +/- 8.88 Hu [P < 0.05]. Contrast media cost in-group A was lower than group B [P < 0.05]. No statistical difference was found in the rate of diagnostic patients between the two groups [P = 0.416]. The estimated radiation dose of group A was 26.0% reduced compared with group B [0.74 +/- 0.34 mSv vs. 1.00 +/- 0.48 mSv, P < 0.05]

Conclusion: in patients with regular and low heart rates, the prospectively high-pitch spiral acquisition mode can reduce radiation dose and contrast media cost while maintaining image quality compared with the prospectively sequential mode

Environmental behavior of pahs in dianchi lake distributions, sources and risk assessment of poly cyclic aromatic hydrocarbons in surface sediments from Dianchi Lake,China

Polycyclic aromatic hydrocarbons [PAHs] in the priority controlling list of US EPA were systematically evaluated in surface sediments in Dianchi Lake and its estuaries. Total PAH concentrations [IPAHs] varied from 210 to 11,070 ng/gdry weight [d.w] in Dianchi Lake, and from 230 to 12,271 microg/g d.w. in the estuaries. IPAHs in sediments from Caohai section were higher than those from Waihai section. The occurrences of PAHs in the Lake were closely related to the distributions of rivers, indicating that the river runoff was an important pathway of PAHs into the Lake. Compared with the US Sediment Quality Guidelines [SQGs], IPAHs in most area were below the effect range low [ERL], which implied that the adverse biological effects would occur rarely. The toxic equivalent concentrations of potentially carcinogenic PAHs [TEQ[carc]] varied from 19to967ngTEQ/gd.w., and the higher values were found in northern Caohai area. The proportions of the toxic equivalent quantity [TEQ[carc]] to the total TEQs in sediments were all above 96%, suggesting that the carcinogenicity of PAHs could be occurred. Significantly positive correlations between total organic carbon [TOC] and less molecular weight PAHs [2, 3-ring] [LPAHs] were observed in the Lake. Diagnostic ratios showed that the primary source of PAHs in Dianchi Lake and most estuaries is biomass combustion, but is petroleum combustion or petrogenic origin in several other estuaries