Application value of Overlap guiding tube in Overlap esophagojejunostomy of laparoscopic total gastrectomy / 中华消化外科杂志

Objective:To investigate the application value of Overlap guiding tube (OGT) in Overlap esophagojejunostomy of laparoscopic total gastrectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients with gastric cancer who were admitted to Nanfang Hospital of Southern Medical University from June to July in 2021 were collected. There were 3 males and 2 females, aged from 48 to 61 years, with a median age of 54 years. Patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative anastomotic stenosis and esophageal reflux up to September 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(IQR) or M(range). Count data were represented as absolute numbers. Results:(1) Surgical situations: 5 patients underwent laparoscopic total gastrectomy combined with OGT-assisted Overlap esophagojejunostomy and D 2 lymph node dissection success-fully, achieving R 0 resection. There was no combined organ resection, intraoperative conversion to laparotomy or combined thoracotomy. There was no intraoperative conversion to other esophagoje-junostomy method either. The tumor diameter, length of surgical incision, the number of lymph nodes dissected, time of esophagojejunal anastomosis, time of digestive reconstruction, operation time, volume of intraoperative blood loss of 5 patients were 3.0(2.8)cm, 5.0(2.0)cm, 47.0(21.0), 21.0(5.0)minutes, 62.0(23.0)minutes, 295.0(75.0)minutes, and 50.0(60.0)mL, respectively. The anvil fork of linear stapler was successfully inserted into esophageal lumen by once operation in 4 cases of 5 patients and by twice operation in 1 case to complete the esophagojejunostomy. (2) Post-operative situations: the time to first out-of-bed activities, time to postoperative first anal flatus, time to postoperative initial liquid diet intake, time to postoperative initial semi-liquid diet intake, time to abdominal drainage tube removal, duration of postoperative hospital stay of 5 patients were 2.0(1.0)days, 3.0(2.0)days, 4.0(3.0)days, 6.0(3.0)days, 7.0(4.0)days, and 9.0(6.0)days, respectively. Results of postoperative pathological examination of 5 patients showed gastric adenocar-cinoma in all the 5 patients, with the TNM staging as stage pT2-4aN0M0. The esophageal surgical margin was negative in all cases, and the length of proximal margin from esophagus was 5.0(4.0)cm. None of the 5 patients developed anastomotic leakage, anastomotic bleeding or anastomotic stenosis. Two cases with mild pneumonia (Clavien-Dindo grade Ⅱ) were cured by conservative treatment such as anti-infection and expectoration promotion. There was no unplanned secondary surgery or perioperative death occurred to the 5 patients. (3) Follow-up: 5 patients were followed up for 3 months. None of the 5 patients developed anastomotic stenosis or esophageal reflux during the follow-up. Conclusion:OGT-assisted Overlap esophagojejunostomy of laparoscopic total gas-trectomy is safe and feasible, with good short-term effects.

Clinical efficacy of laparoscopic and open distal gastrectomy for gastric cancer in elderly patients: an interim analysis of prospective study / 中华消化外科杂志

Objective:To analyze the interim clinical efficacy of laparoscopic and open distal gastrectomy for gastric cancer in elderly patients.Methods:The prospective randomized controlled study was conducted. The clinicopathological data of 102 patients aged ≥65 years who underwent distal gastrectomy for gastric cancer in the Nanfang Hospital of Southern Medical University from September 2014 to May 2018 were collected. After excluding 6 patients, 96 patients were finally included. Based on random number table, patients were allocated into two groups. Patients undergoing laparoscopic distal gastrectomy were allocated into laparoscopic group, and patients undergoing open distal gastrectomy were allocated into open group, respectively. Obser-vation indicators: (1) grouping situations of the enrolled patients; (2) intraoperative situations; (3) postoperative situations; (4) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect complications in the postoperative 30 days up to July 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M( P25, P75) or M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the non-parameter Mann-Whitney U test. Results:(1) Grouping situations of the enrolled patients: a total of 96 patients were selected for eligibility. There were 66 males and 30 females, aged from 65 to 85 years, with a median age of 69 years. There were 49 of 96 patients in the laparoscopic group and 47 patients in the open group. (2) Intraoperative situations: patients in the two groups underwent distal gastrectomy successfully with D 2 lymphadenectomy, without intra-operative conversion to laparotomy. The volume of intraoperative blood loss and surgical incision length were 50 mL(50 mL,100 mL) and (7.1±1.7)cm for the laparoscopic group, respectively, versus 100 mL(100 mL,200 mL) and (19.1±1.7)cm for the open group, showing significant differences between the two groups ( Z=?3.779, t=?34.880, P<0.05) . (3) Postoperative situations: the number of lymph node dissected, time to postoperative initial out-of-bed activities, time to postoperative first flatus, time to postoperative first liquid food intake, time to postoperative first semi-liquid food intake, time to drainage tube removal, duration of postoperative hospital stay were 49(35,62), 1.9 days(1.3 days,2.9 days), 2.6 days(2.2 days,2.9 days), 3.4 days(2.7days,4.0 days), 5.9 days(4.7 days,7.7 days), 4.9 days(3.5 days,6.8 days), 7.7 days(6.7 days,8.9 days) for the laparoscopic group, respectively, versus 40(27,51), 2.5 days (1.8 days,3.3 days), 2.6 days(2.2 days,2.9 days), 3.9 days(2.9 days,5.7 days), 4.9 days(3.9 days, 5.9 days), 6.3 days(4.7 days,8.9 days), 8.7 days(6.9 days,11.7 days), showing significant differences between the two groups ( Z=?2.354, ?2.210, ?2.743, ?2.474, ?2.906, ?2.503, ?2.359, P<0.05). (4) Follow-up: patients in the two groups received 30 days of follow-up. During the follow-up, 8 patients in the laparoscopic group had postoperative complications, including 1 case with Clavien-Dindo grade Ⅰ complications, 7 cases with Clavien-Dindo grade Ⅱ complications, and no patient with Clavien-Dindo grade Ⅲ complications. Thirteen patients in the open group had postoperative complications, including 2 cases with Clavien-Dindo grade Ⅰ complications, 10 cases with Clavien-Dindo grade Ⅱ complications, and 1 case with Clavien-Dindo grade Ⅲ complications. There was no significant difference in the above indicators between the two groups ( χ2=1.135, 1.973, 1.054, P>0.05). The overall complication rate was 16.3%(8/49) and 27.7%(13/47) for the laparoscopic group and open group, respectively, showing no significant difference between the two groups ( χ2=1.803, 99.7% confidence interval as ?∞ to 2.4%, P>0.05). The upper limit of 99.7% confidence interval was less than non-inferiority level of 15%, interim analysis of which showed that the complication rate of the laparoscopic group was non-inferior to the open group. Conclusion:For elderly patients undergoing laparoscopic or open distal gastrectomy for gastric cancer, laparoscopic surgery does not increase intraoperative or postoperative complications, and has advantages of minimally invasiveness, fine operation, quicker recovery, and shorter hospital stay. Registry: this study was registered at clinicaltrials.gov in United States, with the registry number of NCT02246153.

Progress in the Treatment of Tachyarrhythmia by Pulsed Electric Field Ablation Catheter Ablation / 中国医疗器械杂志

Pulsed electric field(PEF) provides high-energy instantaneous pulse and release energy to myocardial cell membrane, resulting in irreversible electroporation and causes myocardial cell contents leakage, destruction of intracellular homeostasis, cell death, and slight inflammatory response. PEF as non-thermal energy promotes the design and application of arrhythmia ablation catheter to enter a new stage. There are currently limited clinical studies that have proved the safety and effectieness of Farawave PEF catheter, PVAC GOLD PEF catheter, Lattice-tip Sphere-9 PEF and radiofrequency (RF) catheter used for atrial fibrillation ablation, but still need further discussion. The research of atrial fibrillation ablation with PEF is under study in China. In this paper, the design and application of PEF ablation for tachyarrhythmia are reviewed.

Immune response triggered by the ablation of hepatocellular carcinoma with nanosecond pulsed electric field / 医学前沿

Nanosecond pulsed electric field (nsPEF) is a novel, nonthermal, and minimally invasive modality that can ablate solid tumors by inducing apoptosis. Recent animal experiments show that nsPEF can induce the immunogenic cell death of hepatocellular carcinoma (HCC) and stimulate the host's immune response to kill residual tumor cells and decrease distant metastatic tumors. nsPEF-induced immunity is of great clinical importance because the nonthermal ablation may enhance the immune memory, which can prevent HCC recurrence and metastasis. This review summarized the most advanced research on the effect of nsPEF. The possible mechanisms of how locoregional nsPEF ablation enhances the systemic anticancer immune responses were illustrated. nsPEF stimulates the host immune system to boost stimulation and prevail suppression. Also, nsPEF increases the dendritic cell loading and inhibits the regulatory responses, thereby improving immune stimulation and limiting immunosuppression in HCC-bearing hosts. Therefore, nsPEF has excellent potential for HCC treatment.

Research progress in treatment for advanced gastric cancer / 中华消化外科杂志

The prognosis of advanced gastric cancer (AGC) is extremely poor. There is no standard and satisfactory treatment strategy for AGC. In clinical practice, some AGC patients can achieve long-term survival. However, it is not clear which type of AGC can benefit the best in specific treatment mode. Because of the high heterogeneity of AGC, it is particularly important to further dig out more significant beneficiary groups. Therefore, experts put forward the classification based on the biological characteristics and the surgery-oriented classification to predict and select patients who benefit from conversion therapy. While for immunotherapy, the biomarkers, molecular subtyping and potential combination strategies are explored to break through its bottleneck in the treatment in AGC that only certain individuals benefit from it. The authors review the research progress in treatment for advanced gastric cancer.

Diagnosis and treatment of primary hyperparathyroidism in pregnancy: analysis of six cases / 中华围产医学杂志

Objective:To study the clinical manifestations, diagnosis and treatment of primary hyperparathyroidism (PHPT) in pregnancy.Methods:This study involved six pregnant patients with PHPT who were admitted to Ruijin Hospital of Shanghai Jiao Tong University from August 2014 to November 2019. Their clinical manifestations, treatment strategies (multidisciplinary consultation with departments including Obstetrics, Endocrinology, Neonatology, General Surgery, Anesthesiology and Intensive Care Unit), maternal complications and maternal and infant outcomes were described and retrospectively analyzed.Results:(1) The median age of the six patients was 34(23-38) years old. PHPT was diagnosed in one case before pregnancy, four in the second or third trimester and one after delivery. The main clinical manifestations of four cases were nausea, vomiting, anorexia and other non-specific symptoms. Anemia was the most common maternal complication (five cases). Other complications included hypercalcemia crisis with renal failure (one case), multiple bone destruction and osteoporosis (one case). The median levels of serum calcium, parathyroid hormone and 25-hydroxyvitamin D were 3.08 (2.84-4.21) mmol/L, 216.7(93.1-2 603.6) ng/L and 29.66 (13.50-90.24) nmol/L, respectively. Results of parathyroid ultrasonography showed all patients had hypoechoic focus. Four cases underwent routine parathyroid radionuclide imaging showing abnormal radioactive concentration areas. (2) Obstetricians initiated the multidisciplinary team (MDT) for all patients to determine the treatment plans after communication with the patients and their families. One case received surgical treatment five months after delivery. Three cases received surgical treatment in the second trimester and among them, one terminated the pregnancy in the second trimester and the other two continued and achieved good pregnancy outcomes. Two cases underwent surgical treatment after giving up pregnancy and induced abortion. Postoperative pathology revealed that five cases were isolated parathyroid adenoma and one was parathyroid carcinoma. All of the patients were followed up and no abnormal serum calcium was reported. (3) One newborn had hypocalcemic convulsions one month after birth and was recovered by intravenous calcium supplementation. The newborn was followed up and the serum calcium level was normal so far. The other two neonates had normal serum calcium during follow-ups, but one of them was diagnosed with autism at the age of four and is now undergoing rehabilitation treatment.Conclusions:Pregnancy complicated by PHPT may lead to serious maternal and infant complications. MDT consultation ensures timely diagnosis, comprehensive treatment for the patients and better pregnancy outcomes.

Role of magnetic resonance angiography in evaluation of patients with moyamoya disease / 国际脑血管病杂志

Compared with traditional cerebral angiography, magnetic resonance angiography has the advantages of non-invasive, convenient, and no adverse effects of contrast agents. In many cases, it can be used as an alternative examination or an important supplement to digital subtraction angiography. This article reviews the application progress of magnetic resonance angiography in the diagnosis and treatment of moyamoya disease.

Nanosecond pulse ablation of hepatocellular carcinoma effect on the immune cells in the liver region of mice / 中华肝胆外科杂志

Objective@#To analyze the changes of local immune cells in liver of mice caused by nanosecond pulse therapy for hepatocellular carcinoma.@*Methods@#Forty C57BL-6J of mice were randomly divided into four groups: negative control group (n=10), tumor group (n=10), surgical resection group (n=10) and nanosecond pulse group (n=10). Hepa 1-6 cells were injected into the left hepatic lobe of mice in tumor group, resection group and nanosecond pulse group to construct the orthotopic xenograft tumor model. Left hepatic lobectomy was performed in the surgical excision group and nanosecond pulse was performed in the nanosecond pulse group 7 days after the construction. All mice were sacrificed 7 days after the treatment. CD3＋ was detected by flow cytometry in the left hepatic lobe lesion, the nanosecond pulse group and the normal liver tissue of the right hepatic lobe in the liver and tumor groups of the blank control group. T, CD4＋T, CD8＋T, regulatory T cells (Treg), myeloid-derived suppressor cells (MDSC), natural killer cells (NK), B cells, and the ratio of CD4＋T to CD8＋T.@*Results@#In the blank control group, the tumor group the number of lesion in the mice and the pulse area of the nanosecond pulse group CD4＋T cells in blank control group (normal liver)>nanosecond pulse group>tumor group [(25.77±3.76)% vs. (15.72±2.70)% vs. (12.68±3.13)%, P<0.05]; CD8＋T cell tumor group>blank control group>nanosecond pulse group [(14.01±2.75)% vs. (13.99±1.41)% vs. (8.42±2.21)%, P<0.05]. The ratio of CD4＋T to CD8＋T in nanosecond pulse group > blank control group > tumor group [(1.90±0.17) vs. (1.86±0.32) vs. (0.93±0.21), P<0.05]; B cell nanosecond pulse group> blank control group > tumor group [(47.65±3.77)% vs. (33.74±3.91)% vs. (15.94±6.10)%, P<0.05]; MDSC cell tumor group > nanosecond pulse group > blank control group [(18.49±2.74)% vs. (8.41±3.05)% vs. (2.15±0.69)%, P<0.05]. However, CD3＋T cells, NK cells and Treg cells showed no statistical significance among the three groups (all P>0.05). Normal liver tissue in right lobe of liver in 4 groups the ratio of CD4＋T to CD8＋T in blank control group >nanosecond pulse group >surgical resection group >tumor group [(1.86±0.32) vs. (1.85±0.43) vs. (1.52±0.16) vs. (1.36±0.29), P<0.05]; B cell nanosecond pulse group >surgical resection group >blank control group> Tumor group [(46.85±8.30)% vs. (34.23±6.17)% vs. (33.74±3.91)% vs. (27.64±2.20)%, P<0.05]; Treg cell tumor group >resection group>nanosecond pulse group>blank control group [(26.34±6.23)% vs. (7.01±2.04)% vs. (3.63±1.59)% vs. (3.19±1.50)% , P<0.05]; MDSC in tumor group >resection group>nanosecond pulse group>blank control group [(12.22±2.02)% vs. (5.00±0.73)% vs. (2.87±0.96)% vs. (2.15±0.69)%, P<0.05]. However, there were no statistically significant differences in CD3＋T, CD4＋T, CD8＋T and NK cells among the four groups (all P>0.05).@*Conclusion@#Nanosecond pulse ablation of primary hepatocellular carcinoma of mice can induce immune response in ablation area and other hepatic lobes, which may be due to the anti-tumor immunity induced by nanosecond pulse.

Nanosecond pulse ablation of hepatocellular carcinoma effect on the immune cells in the liver region of mice / 中华肝胆外科杂志

Objective To analyze the changes of local immune cells in liver of mice caused by nanosecond pulse therapy for hepatocellular carcinoma. Methods Forty C57BL-6J of mice were randomly divided into four groups:negative control group ( n=10 ) , tumor group ( n=10 ) , surgical resection group (n=10) and nanosecond pulse group (n=10). Hepa 1-6 cells were injected into the left hepatic lobe of mice in tumor group, resection group and nanosecond pulse group to construct the orthotopic xenograft tumor model. Left hepatic lobectomy was performed in the surgical excision group and nanosecond pulse was performed in the nanosecond pulse group 7 days after the construction. All mice were sacrificed 7 days after the treatment. CD3+ was detected by flow cytometry in the left hepatic lobe lesion, the nanosecond pulse group and the normal liver tissue of the right hepatic lobe in the liver and tumor groups of the blank control group. T, CD4+T, CD8+T, regulatory T cells (Treg), myeloid-derived suppressor cells (MDSC), natural killer cells (NK), B cells, and the ratio of CD4+T to CD8+T. Results In the blank control group, the tumor group the number of lesion in the mice and the pulse area of the nanosecond pulse group CD4+T cells in blank control group (normal liver) >nanosecond pulse group >tumor group [(25. 77 ± 3. 76)％ vs. (15. 72 ± 2. 70)％ vs. (12. 68 ± 3. 13)％, P<0. 05]; CD8+T cell tumor group>blank control group>nanosecond pulse group [(14. 01 ± 2. 75)％ vs. (13. 99 ± 1. 41)％ vs. (8. 42 ± 2. 21)％, P<0. 05]. The ratio of CD4+T to CD8+T in nanosecond pulse group > blank control group > tumor group [ ( 1. 90 ± 0. 17) vs. (1. 86 ± 0. 32) vs. (0. 93 ± 0. 21), P<0. 05];B cell nanosecond pulse group> blank control group > tumor group [(47. 65 ± 3. 77)％ vs. (33. 74 ± 3. 91)％ vs. (15. 94 ± 6. 10)％, P<0. 05];MDSC cell tumor group > nanosecond pulse group > blank control group [(18. 49 ± 2. 74)％ vs. (8. 41 ± 3. 05)％ vs. (2. 15 ± 0. 69)％, P<0. 05]. However, CD3+T cells, NK cells and Treg cells showed no statistical significance among the three groups (all P>0. 05). Normal liver tissue in right lobe of liver in 4 groups the ratio of CD4+T to CD8+T in blank control group >nanosecond pulse group >surgical resection group >tumor group [(1. 86 ± 0. 32) vs. (1. 85 ± 0. 43) vs. (1. 52 ± 0. 16) vs. (1. 36 ± 0. 29), P<0. 05]; B cell nanosecond pulse group >surgical resection group >blank control group > Tumor group [(46. 85 ± 8. 30)％ vs. (34. 23 ± 6. 17)％ vs. (33. 74 ± 3. 91)％ vs. (27. 64 ± 2. 20)％, P<0. 05];Treg cell tumor group >resection group>nanosecond pulse group>blank control group [(26. 34 ± 6. 23)％vs. (7. 01 ± 2. 04)％ vs. (3. 63 ± 1. 59)％ vs. (3. 19 ± 1. 50)％ , P<0. 05]; MDSC in tumor group>resection group > nanosecond pulse group > blank control group [ ( 12. 22 ± 2. 02 )％ vs. ( 5. 00 ± 0. 73)％ vs. (2. 87 ± 0. 96)％ vs. (2. 15 ± 0. 69)％,P <0. 05]. However, there were no statistically significant differences in CD3+T, CD4+T, CD8+T and NK cells among the four groups ( all P >0. 05 ) . Conclusion Nanosecond pulse ablation of primary hepatocellular carcinoma of mice can induce immune response in ablation area and other hepatic lobes, which may be due to the anti-tumor immunity induced by nanosecond pulse.

Method and experience of lymph node examination after gastrectomy with D2 lymphadenectomy for gastric cancer / 中华胃肠外科杂志

The insufficiency of the examined number of lymph nodes after surgery for gastric cancer may undermine the stage of lymph node metastasis, which would have a significant impact on prognostic evaluation and strategy formulation of adjuvant therapy. Under the premise of standard D2 lymphadenectomy, the number of harvested lymph nodes is mainly dependent on the procedures of lymph node examination. Since 2013, our center has set up a special lymph node examination team. In the same year, the average number of harvested lymph nodes in each sample was 46, which was significantly higher than before (average 18 nodes/case in 2004-2012). After continuous quality improvement and regular quality control in 2014, average number of retrieved lymph nodes was 64 per specimen. Therefore, this paper summarizes the methods and experience of lymph node examination in gastric cancer specimens of general surgery in Southern Hospital. The overall construction of the lymph node examination team of gastric cancer in our center mainly includes three parts: establishment of a specialized lymph node examination team, effective standard operating procedures (SOP), and long-term and sustained quality control. The specialized lymph node examination team consists of postgraduate students who are not involved in surgery but have been trained by surgeons. Standard procedures include theoretical reserve of gastric anatomy, surgical observation to correspond to specimens in vitro and in vivo, and standardized specimen processing procedures. Long-term and sustained quality control requires periodic report of lymph node examination data and continuous feedback optimization of the process. Intraoperative lymph node tracing navigation and specimen lymph node intensification are carried out with nanocarbon and indocyanine green dye staining, and then lymph nodes are harvested based on the traditional methods, which can improve the examination rate of lymph nodes, especially for small lymph nodes. Research on lymph node tracing methods, requires multidisciplinary cooperation in particular, will become a hot topic.

Preliminary experience of dual-port laparoscopic distal gastrectomy for gastric cancer / 中华胃肠外科杂志

OBJECTIVE@#To evaluate the short-term efficacy and cosmetic effect of dual-port laparoscopic distal gastrectomy (DPLDG) for gastric cancer.@*METHODS@#Thirty consecutive patients underwent DPLDG at the Department of General Surgery, Nanfang Hospital from November 2016 to August 2018.@*INCLUSION CRITERIA@#(1) age of 18 to 75 years; (2) primary gastric adenocarcinoma confirmed pathologically by endoscopic biopsy; (3) tumor located at middle-low stomach and planned for distal gastrectomy; (4) cT1b-2N0-1M0 at preoperative staging; (5) tumor diameter ≤3 cm; (6) US Eastern Cancer Cooperative Group(ECOG) score 0 to 1 points; (7) American Society of Anesthesiologists grade I to II; (8) perioperative management based on enhanced recovery after surgery (ERAS) principle.@*EXCLUSION CRITERIA@#previous upper abdominal surgery (except laparoscopic cholecystectomy), history of other malignant disease, and body mass index ≥30 kg/m². A self-developed single-incision, multiport, laparoscopic surgery Trocar (Surgaid Medical, Xiamen, China, comprising 3 channels for observation, main surgeon and assistant surgeon) was placed through a 3-4 cm incision under or at the left side of the umbilicus. An additional 5 mm Trocar was inserted under the rib margin of the right clavicle to serve as the secondary operating hole and the position of the drainage tube. The liver was suspended to expose the surgical field clearly. Surgical procedure was as follows: conventional laparoscopic instruments were used. After entering the omental sac, dissection was performed along the transverse colon to the spleen flexure. Left gastroepiploic vessels were identified and then ligated at the root. No.4sb lymph nodes were dissected. The No.4d lymph nodes were dissected along the greater curvature of the stomach. Then the dissection was continued rightward to the hepatic flexure to separate mesogastrium and mesocolon. The right gastroepiploic artery was ligated at the root to allow the removal of No.6 lymph nodes. The duodenal bulb was transacted by liner stapler, the right gastric artery was ligated at the root and the No.5 lymph nodes were removed. Peritoneal trunk, common hepatic artery, splenic artery and left gastric artery and vein in posterior pancreatic space at upper pancreas were separated, then left gastric vessels were ligated, and No.9, No.8a, No.11p and No.7 lymph nodes were dissected. The left side wall of portal vein was exposed and No.12a lymph nodes were removed. No.1 and No.3 lymph nodes were dissected along the lesser curvature. The stomach corpus was transacted by liner stapler at 4-5 cm proximal end of the tumor. Roux-en-Y anastomosis or Billroth II anastomosis was performed in the cavity. A drainage tube was placed near the gastrojejunal anastomosis through the right upper abdomen secondary operating hole. Postoperative short-term efficacy (operation time, blood loss, 5-port conversion rate, open conversion rate, number of retrieved lymph nodes, time to postoperative first flatus, time to first soft diet intake, time to removal of drainage tube, postoperative hospital stay, postoperative analgesics use, and postoperative 30-day complication rate) and cosmetic scale (questionnaire: degree of satisfaction with scar, description of scar, grade of scar; total score ranged from the lowest 3 to the highest 24; the higher the better) were evaluated in all 30 patients.@*RESULTS@#No serious complication and death were observed intraoperatively. The mean operative time was (197.8±46.9) minutes. The median blood loss was 30 ml (quartile 31.25 ml). The mean number of retrieved lymph node was 38.7±14.1. Five-port conversion rate was 3.3% (1/30), and no open conversion occurred. Mean time to postoperative first flatus, time to first soft diet intake, time to removal of drainage tube and postoperative hospital stay were (45.3±18.9) hours, (87.6±35.6) hours, (101.8±58.0) hours and (6.1±2.1) days, respectively. Twenty-four (80%) of patients had no additional analgesics use. The postoperative complication rate within 30 days was 16.7% (5/30). Postoperative overall cosmetic score was 22.1±1.3, and cosmetic score of 96.7%(29/30) of patients was 18 to 24.@*CONCLUSION@#DPLDG is safe and feasible with advantages of faster postoperative recovery, reducing pain and better cosmetic outcomes.

Maternal and infant outcomes after elective neurosurgery for occupying lesions in saddle area during pregnancy / 中华围产医学杂志

Objective To investigate the perinatal outcomes after elective neurosurgery in pregnant women complicated by space-occupying lesions in saddle area.Methods Clinical data were retrospectively collected and analyzed from five gravidas with space-occupying lesions in saddle area,who underwent neurosurgery at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2017 to February 2018,including gestational age,perioperative management,surgical procedures,postoperative complications,pregnancy outcomes and pathological results.Results (1) Progressively deteriorated impaired vision was the chief complaint of all five patients.Space-occupying lesions in saddle area were detected by cranial MRI (plain scan).The surgical indication was clear as there was compression on optic nerve and a risk of blindness due to optic nerve atrophy,Two patients were operated in the third trimester and three in the second trimester.Postoperative pathology showed there were two cases with meningioma,two with pituitary macro adenoma and one with abscess of pituitary.Only one patient had mild postoperative cerebrospinal fluid rhinorrhea,which was improved three months later,and no complications were reported in the other four cases.All five patients had obvious improvement of vision after surgical intervention and no relapse was reported during a follow-up of 4-12 months.(2) Four gravidas continued their pregnancies to full or nearly full term,among which three underwent cesarean section due to obstetrical indications (one breech pregnancy,one twin pregnancy with scarred uterus and one complicated by hypertensive diseases of pregnancy with poor blood pressure control) and one delivered vaginally.Postpartum involution of the uterus was well in all of the four cases 42 d after delivery.The women with pituitary abscess terminated the pregnancy due to intraamniotic injection of ethacridine lactate at 20 weeks of gestation.Five neonates were all born with Apgar scores of 10 at 1,5 and 10 min without any visible defects at birth and all grew and developed normally at 4-12 months after birth.Conclusions For gravidas with space-occupying lesions in saddle area,it is necessary to weigh the pros and cons and choose an individualized treatment plan.Resection of saddle area lesions in the second or third trimester backed by a multidisciplinary team is a safe and feasible procedure if postponing the operation until delivery may cause irreversible or even life-threatening consequences.

Successful twin pregnancy after valve replacement in second trimester due to maternal infective endocarditis / 中华围产医学杂志

We reported a case of infectious endocarditis in second trimester of a twin pregnancy. The patient was admitted for "recurrent fever for 5 weeks and left limb hemiplegia for 2 weeks" at 27+2 gestational weeks and underwent aortic biovalve replacement and periaortic valve abscess isolation. Warfarin was given to anticoagulant after operation. The pregnancy was terminated by cesarean section at 35+2 gestational weeks. She and her infants recovered after operation. Clinical manifestations of gestational infectious endocarditis are insidious. Diagnosis promptly and treatment by multidisciplinary collaboration is indispensable.

Safety evaluation and application of esophagojejunostomy in laparoscopic total gastrectomy / 中华消化外科杂志

The esophagojejunostomy is a key and difficult point in laparoscopic total gastrectomy (LTG),it mainly uses circular stapler and Endo-cutter.The circular stapler includes trans-orally inserted anvil (OrVilTM),purstring instrument,manual anastomosis,anti-puncture placement,etc;The Endo-cutter includes esophagus-jejunum side-to-side anastomosis and overlap side-to-side anastomosis.There are their respective advantages and limitations in the various esophagojejunostomy,no standard is recommended.When it comes to security,overlap side-to-side anastomosis is better for patients with non-upper gastric cancer,and OrVilTM really has a leading-edge advantage compared with other anastomoses and may be used for patients with upper gastric cancer who cannot undergo linear anastomosis.The above anastomosis methods need to be proved by the high-quality,large-sample randomized controlled clinical studies.

Reliability and validity of the retranslated China version of Nurses′Global Assessment of Suicide Risk scale / 中国实用护理杂志

Objective To retranslate the Nurses′ Global Assessment of Suicide Risk scale (NGASR) into Chinese, and then to test the reliability and validity of the Chinese version of NGASR. Methods Standard forward-back translation techniques and Chinese cultural adaptation were used in the translation of the NGASR according to the Brislin translation model and then Chinese cultural adapted The reliability and validity of Chinese version of NGASR were tested in 209 psychiatric inpatients who were admitted to hospital into two days. Results The contents were obtained between the Chinese cultural adapted version and original scale. The internal consistency reliability is 0.878 which was showed by KR20, The spearman correlation coefficient was 0.90 (P<0.01) which was represented the intraobserver reliability. Five factors were abstracted by exploratory factor analysis, which could explain 57％of the total variance. The spearman correlation coefficient with Beck Hopelessness Scale (BSS) and Beck Scale for Suicide Ideation-Chinese Version (BSI-CV) were 0.50 and 0.37 (P<0.01). Conclusion The China version of NGASR demonstrates good reliability and content validity, which can be used to assess suicide inpatients with psychiatric in China.

Progress in prophylatic hyperthermic intraperitoneal chemotherapy for advanced gastric carcinoma / 中华胃肠外科杂志

Advanced gastric cancer (AGC) has a high recurrence rate (especially peritoneal relapse) and a poor prognosis. Systematic chemotherapy or targeted therapy have not been able to significantly reduce the major cause of an unfavorable prognosis, namely the high peritoneal AGC recurrence rate post-surgery. Further studies concerning the application of hyperthermic intraperitoneal chemotherapy (HIPEC) post curative surgery for AGC patients, namely the prophylactic HIPEC (P-HIPEC), have involved a prophylactic approach to prevent peritoneal relapse following curative gastrectomy in high-risk patients. Theoretically, breaking the "plasma-peritoneal barrier" increases cytotoxic chemotherapy activity via a synergistic hyperthermic effect; therefore, HIPEC can eradicate free cancer cells and micro-metastasis within the peritoneal cavity intraoperatively or soon after curative gastrectomy to reduce peritoneal recurrence. Many clinical trials have shown that P-HIPEC can reduce peritoneal recurrence and improve prognosis of AGC patients. However, some studies applying HIPEC at an early stage have revealed a high rate of complications that limited generalizability. This procedure has been increasingly adopted, given the complication rate has now been reduced and safety has been proven. Recently, for assessing the important role of HIPEC, many high-quality prospective randomized controlled clinical trials have been conducted to further investigate the best guidance for P-HIPEC and to demonstrate its effectiveness and safety with a higher grade of evidence. With theory development, the technique, equipment, and management of HIPEC and the role of P-HIPEC for AGC continues to evolve. This study summarizes the progress of P-HIPEC for high-risk AGC patients.

Clinical research status of laparoscopic gastric cancer surgery in China, Japan and South Korea / 中华胃肠外科杂志

Laparoscopic surgery has its unique minimally invasive advantages, however, taking the complex and difficult D2 lymph node dissection for advanced gastric cancer into consideration, laparoscopic gastrectomy was only applied in the treatment of early gastric cancer at its preliminary stage. With the development of more than a decade, many multicenter clinical data have confirmed the safety, feasibility and effectiveness of laparoscopic radical gastrectomy for early gastric cancer. Based on high-quality evidence-based medicine evidence, laparoscopic gastrectomy has been recommended as an optional treatment for stage I( gastric cancer by the Japanese Gastric Cancer Treatment Guidelines 2014(ver.4). However, the safety and effectiveness of laparoscopic gastrectomy for advanced gastric cancer remains controversial due to the lack of high-level evidence-based clinical evidence. Currently, China, Japan and South Korea are trying to clarify its safety and effectiveness by conducting well-designed multicenter prospective randomized controlled trials. To date, CLASS-01 trial in China, whose secondary endpoint indicated that laparoscopic gastrectomy with D2 lymphadenectomy for advanced gastric cancer can be safely performed by experienced surgeons, has provided the highest level evidence for the controversy in the world. At ASCO 2016, the safety reports from Korea's KLASS-02 trial also presented the similar conclusion. The long-term oncologic outcomes of the both researches were particularly promising. Retrospecting the whole development of gastric cancer surgery, it is not difficult to find that its mainstream direction is gradually shifted from "extended and standardized surgical resection" to "individual and precise surgery" for the safety and postoperative quality of life. The new concept of minimally invasive surgery built on laparoscopic surgery emphasizes more than shortening the surgical incision, but minimizing tissue trauma and maximizing functional preservation. On the ground of this new minimally invasive concept, surgeons have appreciated to select the most rational treatment for an individual patient. Thus, techniques focusing on further assisting laparoscopic gastrectomy with reducing trauma and preserving function, such as sentinel node navigation surgery and related fluorescence molecular imaging techniques, are increasingly being applied in gastric cancer surgery. At present, a series of researches about the feasibility of sentinel node navigation surgery and function preserving surgery associated with gastric cancer surgery are actively conducted or prepared. Results of these researches may further promote the development of laparoscopic gastrectomy and achieve the qualitative change in minimally invasive surgery in the new era.

Surgical safety of laparoscopic total gastrectomy with intracorporeal esophagojejunostomy via transoral anvil versus mini-laparotomy anastomosis: a propensity score matching analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of intracorporeal Roux-en-Y esophagojejunostomy via the transoral anvil(OrVil) by mini-laparotomy anastomosis during laparoscopic total gastrectomy (LTG) for gastric cancer.</p><p><b>METHODS</b>From March 2010 to December 2016, 414 consecutive gastric adenocarcinoma patients underwent either intracorporeal Roux-en-Y esophagojejunostomy (n=43) via the OrVil or extracorporeal circular anastomosis (n=371) via auxiliary incision during LTG. After generating propensity scores with six covariates, including gender, age, body mass index (BMI), neoadjuvant chemotherapy, tumor location, and tumor size, 43 patients undergoing OrVil method (OrVil group) were matched with 43 patients undergoing extracorporeal circular anastomosis approach (extracorporeal anastomosis group). Operation-associated parameters and safety were compared between the two groups.</p><p><b>RESULTS</b>Both groups were balanced regarding baseline variables (all P > 0.05). The total operative time [(235.6±49.8) minutes vs. (221.1±46.5) minutes, t=1.397, P=0.166] and anvil insertion time [(10.0±3.2) minutes vs. (10.6±4.5) minutes, t=-0.671, P=0.504] were not significantly different between the two group, whereas the duration of reconstruction and the mean length of minilaparotomy [(48.3±12.0) minutes vs. (55.9±12.3) minutes, t=-2.899, P=0.005; (5.6±0.6) cm vs. (8.1±2.2) cm, t=-7.118, P=0.001] in the OrVil group were significantly shorter. The number of retrieved lymph nodes, mean blood loss and proximal resection margin were not significantly different between two groups (all P > 0.05). As a whole, OrVil group had advantages over extracorporeal anastomosis group during the postoperative recovery course. The time to liquid intake [(3.7±1.8) days vs. (6.2±7.2) days, t=-2.236, P=0.030], time to fluid diet [(4.8±2.3) days vs. (7.2±7.1) days, t=-2.013, P=0.048], and time to semi-fluid diet [(6.7±2.9) days vs. (10.2±9.6) days, t=-2.245, P=0.029] were significantly shorter in the OrVil group. The first ambulatory time, time to first flatus and length of hospital stay were not significantly different between two groups(all P>0.05). The morbidity of intraoperative complication [7.0%(3/43) vs. 4.7%(2/43), χ²=0.000, P=1.000] and postoperative complication [30.2%(13/43) vs. 20.9%(9/43), χ²=1.484, P=0.223], and even the distribution of severity (χ²=0.013, P=0.990) between the two groups were not significantly different. The incidence of anastomotic leakage (AL) was 9.3% (4/43) and 18.6% (8/43) in the OrVil group and extracorporeal anastomosis group respectively without significant difference (χ²=1.550, P=0.213). Multivariate analysis showed that the OrVil anastomosis was not a risk factor of AL(HR=0.663, 95%CI:0.120-3.674, P=0.638).</p><p><b>CONCLUSIONS</b>Intracorporeal esophagojejunostomy using the OrVil system is more minimally invasive and convenient to operate without increasing the risk of operation-related complication. Thus it may be a potential safe approach to optimize the reconstruction for LTG.</p>

Progress in conversion therapy for originally unresectable gastric cancer / 中华胃肠外科杂志

Conversion therapy is adopted to achieve radical cure for patients with originally unresectable but potentially resectable late stage gastric cancer, who obtain partial or complete remission after systemic chemotherapy, to acquire relatively longer postoperative survival and recurrence-free survival. Some of the previous researches on conversion therapy for originally unresectable gastric cancer suggest that high chemotherapy response rate, high pathological response rate and R0 resection rate are associated with favorable prognosis. And the efficacy of patients with lymphatic metastasis is better than that of those with peritoneal metastasis. The protocol of conversional chemotherapy varies and so does its efficacy according to different reports. Latest clinical researches indicate that initially unresectable gastric cancer gained higher remission rate and better chance of R0 operation and consequently prolonged survival from paclitaxel based triplet chemotherapy. However, not all originally unresectable gastric cancer can benefit from conversion therapy due to the high heterogeneity of its biological behavior. Regarding the enormous number of originally unresectable gastric cancer patients, it will be a research hot spot in the field of surgical oncology, on screening criteria to select cases suitable for conversion. Exploration on conversion therapy for gastric cancer is still at initial stage, and reports that have been published are mostly single-centered with limited sample, lacking of sufficient evidence on its feasibility, safety and efficacy. Expert consensus on conversion indication, case selection, chemotherapy regimen, efficacy assessment and resection range is absent. So it is in urgent need for higher level clinical evidence to support and guide this practice. Such goal can never be achieved without joint efforts of all parties to carry out clinical trial to modify the practice of conversion therapy for late stage gastric cancer, and determine the proper selection of suitable candidates for conversion therapy, eventually to offer optimal strategy for originally unresectable gastric cancer patients. Thus, this article focuses on reviewing research progress of conversion therapy for originally unresectable late stage gastric cancer.

Application of family centered cognitive intervention in neonatal nursing / 中国基层医药

Objective To explore the role of family centered cognitive intervention in neonatal nursing. Methods According to the random number table method,100 newborns were randomly divided into observation group and control group,50 cases in each group. The two groups received routine health education,and the observation group received the family centered cognitive intervention. After the intervention, the neonatal physical development status (body weight,height,head circumference) and neonatal disease status of the two groups were analyzed. The active muscle tension, passive muscle tension, primitive reflexes, behavior ability, general evaluation and neonatal behavioral neurological assessment score ( NBNA score ) were evaluated and analyzed. Results The body weight [(4753.88±434.59)g],length[(55.16±1.17)cm],headcircumference[(37.34±0.51)cm]after1month discharge of the observation group were better than those of the control group[(4295. 78 ± 344. 63) g,(52. 25 ± 0.58)cm,(35.67 ±0.21)cm],the differences between the two groups were statistically significant(t =2.564, 6. 235,8. 679,all P<0. 05). The incidence rate of born disease of the observation group was 14. 00%,which of the control group was 32. 00%,there was statistically significant difference between the two groups(χ2 =4. 574,P <0. 01). The active muscle tension,passive muscle tension,behavior ability,original reflection,the general evaluation and NBNA scores of the observation group were significantly higher than those of the control group, the differences were statistically significant(all P<0. 01). Conclusion Family centered intervention can significantly improve the growth status of newborn infants,reduce the incidence of the disease,it is beneficial to improve the patients' neurological behavior,it is worthy of wide application.