International innovative health technology payment strategy and enlightenment under diagnosis-related groups payment system / 中华医院管理杂志

Under the diagnosis-related groups(DRG) prospective payment system, innovative health technologies with high costs and risks may be limited to some extent. How to balance the increase of health care cost and the development of innovative health technology is a difficult problem to be solved in the current reform. By studying the relatively mature payment systems of innovative health technologies in the world, the authors found that countries generally adopted additional payment or compensation to encourage the development of new technologies. But at the same time, a relatively perfect health technology assessment and payment management mechanism had been established to ensure the standardized operation of payment plan. These international advanced experience and practice could provide references for China′s innovative health technology payment strategy under the DRG payment system. It is suggested to establish a scientific and reasonable assessment mechanism of innovative health technology, create a special access channel for innovative health technology with limited short-term evidence, and gradually form a long-term incentive mechanism of innovative health technology in DRG payment system.

Emodin alleviates hypertrophic scar formation by suppressing macrophage polarization and inhibiting the Notch and TGF-β pathways in macrophages

Hypertrophic scar (HS) formation is a common complication that develops after skin injury; however, there are few effective and specific therapeutic approaches for HS. Emodin has previously been reported to inhibit mechanical stress-induced HS inflammation. Here, we investigated the molecular mechanisms underlying the inhibitory effects of emodin on HS formation. First, we conducted in vitro assays that revealed that emodin inhibited M1 and M2 polarization in rat macrophages. We subsequently established a combined rat model of tail HS and dorsal subcutaneous polyvinyl alcohol (PVA) sponge-induced wounds. Rats were treated with emodin or vehicle (DMEM). Tail scar specimens were harvested at 14, 28, and 42 days post-incision and subjected to H&E staining and Masson's trichrome staining. Histopathological analyses confirmed that emodin attenuated HS formation and fibrosis. Macrophages were separated from wound cells collected from the PVA sponge at 3 and 7 days after implantation. Flow cytometry analysis demonstrated that emodin suppressed in vivo macrophage recruitment and polarization at the wound site. Finally, we explored the molecular mechanisms of emodin in modulating macrophage polarization by evaluating the expression levels of selected effectors of the Notch and TGF-β pathways in macrophages isolated from PVA sponges. Western blot and qPCR assays showed that Notch1, Notch4, Hes1, TGF-β, and Smad3 were downregulated in response to emodin treatment. Taken together, our findings suggested that emodin attenuated HS formation and fibrosis by suppressing macrophage polarization, which is associated with the inhibition of the Notch and TGF-β pathways in macrophages.

miR-377-5p inhibits proliferation and invasion of hepatocellular carcinoma HepG2 cells by down-regulating HIF-1α and related VEGFsignaling pathway / 中国肿瘤生物治疗杂志

@# Objective：To explore the targeting relationship between miR-377-5p and hypoxia inducible factor-1 (HIF-1α), and investigate the regulatory effect of miR-377-5p on proliferation, invasion and epithelial-mesenchymal transition (EMT) of hepatocellular carcinoma (HCC) cells through vascular endothelial growth factor (VEGF) signaling pathway. Methods： ：The expression of miR-377-5p in 35 pairs of human HCC tissues and para-cancerous tissues was detected by qPCR. Then, HepG2 cells were divided into control group, mimic-NC group and miR-377-5pmimicgroup.qPCRwasusedto detect the transfection efficiency; the effects of miR-377-5p over-expression on proliferation and invasion of HepG2 cells were examined by EdU staining and Transwell assay, respectively; and the effect of miR-377-5p over-expression on the expressions of proliferation-related protein Ki-67, proliferating cell nuclear antigen (PCNA) and epithelial-mesenchymal transition (EMT) markers (E-cadherin and N-cadherin) were detected by Western blotting (WB); the effect of miR-377-5p over-expression on the expression of hypoxia inducible factor-1α (HIF-1α) in HepG2 cells was detected by qPCR and WB; and the targeting relationship between miR-377-5p and HIF-1α gene was determined by Luciferase reporter gene assay. Results: The expression of miR-377-5p in HCC tissues was significantly lower than that in para-cancerous tissues (P<0.01). Compared with the control group, the expression of miR-377-5p in HepG2 cells of miR-377-5p mimic group elevated significantly, and the proliferation, invasion and the expression of N-caderin proteins decreased,significantly (all P<0.01), while the expression of E-caderin increased significantly (P<0.01). At the same time, the mRNA and protein expressions of HIF-1α in miR-377-5p mimic group decreased significantly (P<0.01 or P<0.05). miR-377-5p targetedly inhibited the expression of HIF-1α gene and suppressed the activation of VEGF pathway (all P<0.05). Conclusion: miR-377-5p inhibits the proliferation, invasion and EMT of HepG2 cells via targetedly inhibiting HIF-1α expression and suppressing the activation of VEGF signaling pathway.

Effect of Shuangteng Bitong Cataplasm on Inflammatory Cytokines in Plasma and Relevant Factors of Rats with Collagen-induced Arthritis / 中国中医药信息杂志

Objective To study the effect of Shuangteng Bitong Cataplasm on TLR4, MyD88 and NF-κB and inflammatory cytokines in rats with collagen-induced arthritis; To discuss relevant mechanism of action. Methods A CIA model was made by subcutaneous injection of collagen emulsion from rat tail. Rats were randomly divided into normal group,model group,Shuangteng Bitong Cataplasm high-dose and low-dose groups.The contents of TNF-α, IL-1β and IL-6 in plasma were evaluated by ELISA, and the expression levels of TLR4, MyD88 and NF-κB in synovial tissues were evaluated by RT-PCR and Western blot. Results Compared with the model group, the contents of TNF-α, IL-1β and IL-6 in serum decreased remarkably in the Shuangteng Bitong Cataplasm low-dose and high-dose group, and the expression levels of TLR4, MyD88 and NF-κB in synovial tissues decreased remarkably. Conclusion Shuangteng Bitong Cataplasm can inhibit inflammatory reaction and regulate the expressions of relevant factors in synovial tissues to realize the anti-flammatory effects.

Preparation and Preclinical Study of 99mTc-labeled Prostate Cancer Aptamer / 中山大学学报(医学科学版)

[Objective]To radiolabel the PSMA aptamer A10-3.2 with 99mTc , and explore its biological characteristics in vivo and in vitro.[Methods]Using Succinimidyl 6-hydrazinonicotinate hydrochloride (SHNH) as the bifunctional chelating agent to label aptamer A10-3.2 with 99mTc, then tested for the stability in vitro, the specific uptake by prostate cancer LNCaP cells (PSMA+) , the characteristics of SPECT/CT imaging and biodistribution in LNCaP tumor-bearing NOD/SCID mice.[Results]The labeling rate and radiochemical purity of the products (99mTc-SHNH-A10-3.2) are(71.31 ± 6.78)% and 97.03%,respectively. 99mTc-SHNH-A10-3.2 had obvious target specificity for PSMA positive prostate cancer LNCaP cells, its uptake rate was significantly higher than PSMA nega?tive PC-3 cells (P<0.01). And in tumor-bearing mice, the tumor has a certain uptake and a high ratio of the tumor tissue to the mus?cle.[Conclusion]This study successfully constructed 99mTc-labeled PSMA-targeted aptamer A10-3.2, which has a good stability and targeting in vivo and in vitro, has a high tumor tissue/muscle ratio in tumor-bearing mice, which show that it may be a potential target?ed molecular imaging agent for prostate cancer.

Analysis on effect of Thermal Moxibustion combined with Yougui Pills in treating POF of spleen and kidney Yang-deficiency / 重庆医学

Objective To observe the therapeutic effect and security of Thermal Moxibustion combined with Yougui Pills in the treatment of premature ovary failure(POF) of spleen and kidney Yang-deficiency.Methods One hundred and forty-two patients with POF of spleen and kidney Yang-deficiency were randomly divided into the treatment group and control group,71 cases in each group.The observation group were treated with Thermal Moxibustion combined with Yougui Pills,while the control group took oral Yougui Pills,12 weeks as a course of treatment.After treatment,the clinical therapeutic effects,K upperman score,related hormones levels(E2,FSH,LH) and occurrence rate of adverse reactions were compared between the two groups.Results The total efficacy rate of the observation group was 95.77％,which of the control group was 77.46％,and the observation group was significantly better than the control group(P＜0.05);there were significant improvement in the Kupperman score and levels of related hormones after treatment in the two groups(P＜0.05),but the improvement degree of the observation group was superior to the control group(P＜0.05).Conclusion Thermal Moxibustion combined with Yougui Pills can alleviate the clinical symptoms with high safety and higher clinical application value

Comparative observation of Methylprednisolone and gamma globulin in the treatment of acute myelitis / 中国生化药物杂志

Objective To study and analyze the efficacy of Methylprednisolone and gamma globulin in the treatment of acute myelitis. Methods 100 cases of acute myelitis in the second affiliated hospital of Xi'an Jiaotong University were selected as the research objects, and the control group was treated with Dexamethasone. The experimental group was treated with Methylprednisolone combined with gamma globulin. The clinical efficacy, adverse reactions and related clinical indicators of the experimental group and the control group were compared and analyzed. Results The effective rate of the experimental group (92.0 %) was significantly better than (82.0 %) of the control group with statistical difference (P<0.05). There were no obvious adverse reactions in the two groups, the incidence rate was 8.0% and 10.0 % respectively, and there was no significant difference. Time of muscle strength improved two level in the control group (18.90±5.23) d was significantly longer than that (10.87±4.30) d of the experimental group, the experimental group hospitalization time, sensory recovery time and recovery of urinary function and other indicators are better than the control group, with statistical difference (P<0.05). Conclusion Methylprednisolone combined with gamma globulin in the treatment of acute myelitis has ideal efficacy, could significantly improve the patient's muscle strength with high safety.

Comparative observation of Methylprednisolone and gamma globulin in the treatment of acute myelitis / 中国生化药物杂志

Objective To study and analyze the efficacy of Methylprednisolone and gamma globulin in the treatment of acute myelitis. Methods 100 cases of acute myelitis in the second affiliated hospital of Xi'an Jiaotong University were selected as the research objects, and the control group was treated with Dexamethasone. The experimental group was treated with Methylprednisolone combined with gamma globulin. The clinical efficacy, adverse reactions and related clinical indicators of the experimental group and the control group were compared and analyzed. Results The effective rate of the experimental group (92.0 %) was significantly better than (82.0 %) of the control group with statistical difference (P<0.05). There were no obvious adverse reactions in the two groups, the incidence rate was 8.0% and 10.0 % respectively, and there was no significant difference. Time of muscle strength improved two level in the control group (18.90±5.23) d was significantly longer than that (10.87±4.30) d of the experimental group, the experimental group hospitalization time, sensory recovery time and recovery of urinary function and other indicators are better than the control group, with statistical difference (P<0.05). Conclusion Methylprednisolone combined with gamma globulin in the treatment of acute myelitis has ideal efficacy, could significantly improve the patient's muscle strength with high safety.

Analysis on results of blood bacterial contamination quality monitoring related indicators in a blood center / 重庆医学

Objective To find the risk and hidden danger of blood bacterial contamination existence at present and to investigate the method for carrying out the bacterial contamination related quality monitoring.Methods According to the requirements of the blood collection and supplying related laws and regulations standards,the blood bacterial contamination situation was monitored by supervising the personnel during the blood collection and supplying,key equipments,key materials,environment monitoring and sterility test of blood products.Results The total eligible rate of quality monitoring indicators of blood bacterial contamination reached 99.8％,the eligible rate of blood products bacterial contamination monitoring was 100 ％.Conclusion The hygiene quality of blood collection process and blood products all are in good condition.

Patient safety education among chinese medical undergraduates: An empirical study / 华中科技大学学报（医学）（英德文版）

Patient safety education is conducive to medical students' cognition on patient safety and to improvement of medical quality and safety. Developing patient safety education for medical students is more and more widely recognized by World Health Organization and countries all over the world. However, in China, patient safety courses aiming at medical students are relatively few, and there are few reports about the effect of patient safety courses. This paper explored the influence of patient safety curriculum on medical students' attitude to and knowledge of patient safety. The patient safety curriculum was carried out for 2011-grade undergraduates of Tongji Medical College, Huazhong University of Science and Technology. The students participated in the class according to free choice. After the curriculum, the information of gender, major, attended course, attitude toward patient safety, and knowledge of laws and regulations of the 2011-grade undergraduates were collected. After rejecting invalid questionnaires, the number of undergraduates that participated in the survey was 112 (61 students did not take part in the curriculum; 51 took part in). Chi-square test was applied to analyze patient safety education's influence on medical students' attitude to patient safety and their knowledge mastery situation. The influence of patient safety education on the attitude of medical students to patient safety was not significant, but that on their knowledge of patient safety was remarkable. No matter male or female, as compared with medical students who had not accepted patient safety education, they both had a better acquisition of knowledge after having this education (for male students: 95% CI, 4.556-106.238, P<0.001; for female students: 95% CI, 3.183-33.238, P<0.001). Students majoring in Western Medicine had a relatively better mastery of knowledge of patient safety after receiving patient safety education (95% CI, 6.267-76.271, P<0.001). Short-term patient safety education cannot change medical students' stereotyped cognition on matters related to patient safety, but it can effectively enhance their knowledge of laws and regulations of patient safety.

Clinical analysis of 10 patients with Wernicke encephalopathy after major abdominal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the pathogenesis, clinical features, diagnosis and treatment of Wernicke encephalopathy after major abdominal surgery.</p><p><b>METHODS</b>Clinical data of 10 patients with Wernicke encephalopathy after major abdominal surgery in the Zhejiang Provincial People's Hospital from 2000 to 2012 were retrospectively analyzed.</p><p><b>RESULTS</b>Wernicke encephalopathy occurred during 5 to 36 days (mean 22.9 days) after surgery. The main symptoms included vertigo, vagueness, blurred vision, and gait incoordination. MRI showed bilaterally symmetrical enhancement of T1 and T2 signal in thalamus, third ventricle, lateral ventricle and periaqueductal region. With treatment of vitamin B1, 6 patients were completely recovered, and 2 partly recovered, but 2 died.</p><p><b>CONCLUSIONS</b>Surgeons should be aware of Wernicke encephalopathy when treating patients undergoing major abdominal operation who need prolonged fasting postoperatively. Early detection and timely supplement of vitamin B1 can avoid irreversible brain damage.</p>

Effect of andrographolide on proliferation and apoptosis of gastric cancer BGC-823 cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of andrographolide (AD) on proliferation, cell cycle and apoptosis of human gastric cells line BGC-823.</p><p><b>METHODS</b>MTT assay, flow cytometry and Annexin-V/PI double-staining flow cytometry assay were used to evaluate the effect of AD on proliferation, cell cycle and apoptosis of BGC-823 cells respectively. Optical microscope and transmission electron microscopy were used to observe the cell morphological changes.</p><p><b>RESULTS</b>A time- and concentration-dependent proliferative inhibition effect of AD was demonstrated in BGC-823 cells. AD concentration lower than 7.5 mg/L possessed weak inhibitory effect,while concentration between 15.0-60.0 mg/L possessed higher inhibitory effect. The concentration higher than 60.0 mg/L had no significant increase of inhibitory effect. IC50 of AD at 24, 48 and 72 h was (35.3±4.3), (25.5±3.5) and (18.2±2.7) mg/L respectively. Compared with the negative control group, the number of G0/G1 phase cells increased significantly (P<0.05), while the number of S and G2/M phase cells decreased after incubation with AD for 48 h, and the alteration was in a concentration-dependent manner. AD arrested BGC-823 cells at the G0/G1 phase of the cell cycle. After incubation with 7.5, 10.0 and 15.0 mg/L AD for 24 h, the early apoptotic rates of BGC-823 cells were (19.3±4.7)%, (29.4±4.1)% and (52.7±6.7)% respectively, and the late apoptotic rates were (10.8±1.8)%, (10.9±4.7)% and (14.7±4.8)% respectively. Both the early apoptotic rates and the late apoptotic rates increased significantly compared to the control group (all P<0.05),and the alteration was in a concentration-dependent manner.</p><p><b>CONCLUSION</b>Andrographolide can inhibit BGC-823 cells proliferation, arrest BGC-823 cells in G0/G1 phase and induce apoptosis, and may be a potential traditional Chinese medicine with anti-cancer effect.</p>

Structure and level of the stress of nursing students in clinic practice / 中国实用护理杂志

Objective To describe the structure and the level of the stress of nursing students in clinic practice,and supply reference for reform of clinical teaching method.Methods Totally 100 undergraduate nursing students in clinic practice,who would graduate from nursing school and begin to work in 2013,were interviewed and investigated.Results The main stress sources were divided into five aspects:recognition,clinical nursing ability,career development,field response and exhaustion of body and mind.Conclusions The structure and level of the stress of nursing students changed a lot.Some new appropriate reform should be introduced into clinic education,in order to help nursing students to complete psychological change and role adaptation.

Expression of aldo-keto reductase family 1 member B10 in gastric cancer tissues and its clinical significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association of AKR1B10 expression in gastric cancer tissues with clinicopathologic features and prognosis of gastric cancer patients.</p><p><b>METHODS</b>Real-time polymerase chain reaction (RT-PCR) was conducted to detect AKR1B10 mRNA expression in gastric cancer and adjacent gastric mucosa tissues (n=36). AKR1B10 protein expression was measured by immunohistochemistry in primary gastric cancer tissues (n=100) and non-tumorous gastric mucosa tissues (n=70).</p><p><b>RESULTS</b>RT-PCR results confirmed that AKR1B10 was significantly down-regulated in gastric cancer tissues compared with that in paired adjacent mucosa [8.3% (3/36) vs. 91.7% (33/36), P=0.000]. Immunohistochemistry revealed that the percentage of AKR1B10 positive specimens in gastric carcinoma was lower than that in normal specimens [33.0% (33/100) vs. 92.9% (65/70), P=0.000]. The frequencies of positive AKR1B10 in patients was significantly correlated with tumor size (P=0.000), invasive depth (P=0.004), lymph node metastasis (P=0.028), distant metastasis (P=0.031) and TNM stages (P=0.000). The 5-year survival rate of positive AKR1B10 group was significantly higher as compared to negative group (60.6% vs. 32.8%, P<0.01).</p><p><b>CONCLUSION</b>The down-regulation of AKR1B10 expression in gastric cancer may be associated with the progress of gastric cancer is suggestive of poor prognosis.</p>

Application of question-based lectures made by students in the teaching and learning of Field Military Nursing / 中华医学教育探索杂志

Objective To explore the application of question-based lectures made by students in teaching chapter of nuclear chemical and biological weapon damage among field military nursing.Methods The participants were junior students of four-year undergraduate program.Questions on emergency treatment and care of chemical and biological weapon damage were proposed after a lecture by teacher.Students were divided into three groups after class and each group was assigned to a lecture on emergency treatment and care of one kind of weapon damage.Students had to collect information and prepare PPT for the next lecture.After lectures given by students at next class,discussion on the lectures was organized and comments were given by teachers.Results All students approved this kind of teaching activities,97.44％ believed that it can arouse their interest in study,94.87％ participated in the collection of data,89.74％ took part in the discussion,and 87.18％ obtained the sense of achievements.Conclusion Question-based lectures made by students are helpful in stimulating their interest in learning,cultivating their abilities of acquiring and applying knowledge.The teaching activities achieve the preferable results through proper application and meticulous organization.

Curative effect of 3D-CRT combined with gemcitabine concurrently with addition of Kanglaite Injection in treatment of locally advanced pancreatic / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the efficacy of concurrent chemoradiotherapy combined with Kanglaite Injection (KI) for locally advanced pancreatic carcinoma patients.</p><p><b>METHODS</b>Totally 50 patients unsuitable for surgery were randomly assigned to the treatment group and the control group, 25 in each group. Patients in the control group were treated with gemcitabine and concurrent 3D-CRT, while those in the treatment group were also treated with intravenous injection of KI (at 100 mL/d) for 21 successive days, 28 days as one cycle, two cycles with one week interval. The short-term curative effect, the survival time, the improvement of symptoms, the tumor markers, and adverse reactions were respectively observed for two years.</p><p><b>RESULTS</b>The short-term curative effective rate (CR + PR) was 52.17% (12/23), and the disease control rate (CR + PR + SD) was 95.65% (22/23) in the treatment group. The short-term curative effective rate (CR + PR) was 41.67% (10/24), and the disease control rate (CR + PR + SD) was 87.50% (21/24) in the control group. There was no statistical difference between the two groups (P > 0.05). The 2-year survival rate was 34.78% (8/23) in the treatment group, better than that in the control group (25.00%, 6/24). The median survival time was 17.2 months in the treatment group and 12.4 months in the control group with statistical difference (P < 0.05). The response rate of pain relief and weight gain were 75.00% and 82.61% in the treatment group respectively, and they were 50.00% and 54.67% in the control group respectively, showing statistical difference between the two groups (P < 0.05). After treatment, the levels of CA19-9 (U/mL) and CEA (ng/mL) were respectively reduced to 118. 00 +/- 78.89 and 7.41 +/- 2.37 respectively in the treatment group, showing statistical difference when compared with those of the control group (being 216.00 +/- 153.23 and 12.25 +/- 7.53 respectively, P < 0.05).</p><p><b>CONCLUSION</b>The concurrent chemoradiotherapy com- bined with KI for locally advanced pancreatic carcinoma patients obtained better results.</p>

Current status and prospect of surgical treatment for diabetes mellitus / 中华胃肠外科杂志

Diabetes surgery is a new concept in recent years, which means controlling blood sugar or curing diabetes through some surgical methods. From the commencement of bariatric surgery in the 1950s to the discovery of the special function of decreasing blood sugar after these surgeries in 1970s, and then the fast developing of diabetes surgery in the past 30 years, now there seems be a different answer to the question that if we can cure diabetes. In this article, we review the historical evolution, surgical procedure, potential mechanism and outlook of diabetes surgery.

Association of SOX9 expression and prognosis in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the association of SOX9 expression and clinicopathologic factors and prognosis of gastric cancer.</p><p><b>METHODS</b>A retrospective cohort study including 112 gastric cancer patients admitted to the Zhejiang Provincial People's Hospital from 2004 to 2006 was performed. Immunohistochemical analysis was used to evaluate the expression of SOX9 in the 112 specimens of gastric cancer tissues and 70 non-cancerous tissues adjacent to the tumor.</p><p><b>RESULTS</b>Low expression of SOX9 was seen in 5(7.1%) tissues out of 70 non-cancerous tissues adjacent to the tumor. A total of 94(83.9%) patients had varying expression of SOX9, of whom 51(45.4%) had overexpression. Univariate analysis demonstrated that the expression of SOX9 was significantly associated with Lauren classification (P<0.05), tumor invasion(P<0.01), lymph node metastasis(P<0.05), distant metastasis(P<0.05) and tumor stage(P<0.05), however there was no significant association between SOX9 expression and sex, age, histological type, histology differentiation or tumor size. Kaplan-Meier analysis showed that the 5-year survival rate of patients with SOX9 over-expression was significantly lower than that of patients with low expression(29.4% vs. 49.2%, P=0.031). Multivariate Cox regression analysis showed that histology differentiation(P=0.046), tumor invasion(P=0.001), and distant metastasis(P<0.01) were independent prognostic factors for gastric cancer, however the over-expression of SOX9 was not significant(P=0.948).</p><p><b>CONCLUSIONS</b>The expression SOX9 is associated with the growth, invasion, and metastasis of gastric cancer, as well as the prognosis. However, SOX9 expression is not an independent factor for the prognosis in patients with gastric cancer.</p>

The application of uncut Roux-en-Y esophagojejunostomy with distal jejunal pouch on behalf of the stomach surgery in the digestive tract reconstruction after total gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical value of uncut Roux-en-Y esophagojejunostomy with distal jejunal pouch on behalf of the stomach (URYAJP) surgery in the digestive tract reconstruction after total gastrectomy.</p><p><b>METHODS</b>A retrospective analysis of radical resection of the whole stomach in 486 cases of gastric cancer patients, divided into the URYAJP group (n = 189), the P-loop Roux-en-Y behalf of the stomach surgery (PRY) group (n = 150) and pure Roux-en-Y reconstruction (RY) group (n = 147). Three groups were compared in patients with surgical reconstruction time, the occurrence of postoperative complications, the postoperative weight after 6, 12 and 24 months, the single meal food intake and prognostic nutritional index (PNI) and Visick points class situation after 12 and 24 months.</p><p><b>RESULTS</b>(1) The URYAJP group and RY group had no significant difference in digestive tract reconstruction time ((37 ± 6) minutes and (38 ± 6) minutes respectively), but PRY group was significantly prolonged ((47 ± 6) minutes, t = 7.52 and 6.54, P < 0.05). (2) In the comparison of the incidence of complications, URYAJP group has 2.1% rate of Roux stay syndrome (RSS) incidence, significantly less than PRY group (21.3%) and RY group (19.7%) (χ² = 14.84, P < 0.05). (3) In the comparison the postoperative nutritional status, URYAJP group clear asset, showing the degree of ((3.1 ± 1.0) kg) weight loss after 12 months (t = 25.03 and 22.99, P < 0.05). And after 12, 24 months, a single meal eating reached the preoperative level is 94.8% and 96.9% in URYAJP group, while PRY group and RY group is less than 50% (χ(2) = 61.10, 69.17, 65.17 and 73.29, P < 0.05). URYAJP Group reach the preoperative levels of PNI in 24 months after surgery, while PRY and RY group were still lower than per-operation (t = 106.97 and 100.37, P < 0.05). (4) The Visick points class I-II postoperative 12 and 24 months in URYAJP group were 92.7% and 93.8%, significantly better than group B and C (χ² = 10.63, 14.19, 10.10 and 10.74, P < 0.05).</p><p><b>CONCLUSIONS</b>URYAJP surgery give full play to maintain intestinal continuity, simple operation, and advantages of food storage bags, it can reduce the long-term postoperative complications, improve the nutritional status of patients and improve quality of life. It is worthy of promoting a way of gastrointestinal reconstruction.</p>

Clinicopathological characteristics and prognosis of early gastric cancer after gastrectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Assessment of lymph node metastasis (LNM) is important in early gastric cancer (EGC) and affects treatment decisions. However, the relationship between clinicopathological characteristics and LNM in EGC remains unclear. This study therefore explored favorable predictors of LNM in EGC.</p><p><b>METHODS</b>A total of 716 specimens from gastric cancer patients who underwent curative gastrectomy between 1996 and 2003 at Zhejiang Provincial People's Hospital were reviewed. Forty-five cases were EGC, and clinicopathological characteristics such as gender, age, tumor size, location, gross type, differentiation, invasion depth, and vessel involvement were assessed to identify predictive factors for LNM and survival time.</p><p><b>RESULTS</b>The overall cumulative 5-year survival rate of EGC patients was 88.92%. Among these, 22.4% developed LNM, which was associated with a poor 5-year survival rate of only 72.7%. Patients with tumors larger than 2 cm in diameters, with depth of tumor invasion to the submucosa, and with positive lymphatic or nerve involvement were also inclined to have poorer survival performances. EGC limited to the mucosa but poorly differentiated also had a high risk for LNM. Multivariate analysis identified lymphatic invasion and tumor size as independent prognosis factors related to survival in EGC patients.</p><p><b>CONCLUSIONS</b>Careful planning is required in EGC patients at high risk of lymph node metastases. Endoscopic mucosal resection or endoscopic submucosal dissection and laparoscopic partial gastrectomy should be cautiously used in EGC, and curative gastrectomy including lymphatic dissection and postoperative adjuvant therapy might be considered to improve the prognosis.</p>