Assessment of Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Invasion Into the Greater Curvature: A Randomized Clinical Trial.

Importance: The survival benefit of laparoscopic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy (LSTG) for locally advanced proximal gastric cancer (APGC) without invasion into the greater curvature remains uncertain. Objective: To compare the long-term and short-term efficacy of LSTG (D2 + No. 10 group) and conventional laparoscopic total gastrectomy (D2 group) for patients with APGC that has not invaded the greater curvature. Design, Setting, and Participants: In this open-label, prospective randomized clinical trial, a total of 536 patients with clinical stage cT2 to 4a/N0 to 3/M0 APGC without invasion into the greater curvature were enrolled from January 2015 to October 2018. The final follow-up was on October 31, 2021. Data were analyzed from December 2021 to February 2022. Interventions: Eligible patients were randomized to the D2 + No. 10 group or the D2 group. Main Outcomes and Measures: The primary outcome was 3-year disease-free survival (DFS). The secondary outcomes were 3-year overall survival (OS) and morbidity and mortality within 30 days after surgery. Results: Of 526 included patients, 392 (74.5%) were men, and the mean (SD) age was 60.6 (9.6) years. A total of 263 patients were included in the D2 + No. 10 group, and 263 were included in the D2 group. The 3-year DFS was 70.3% (95% CI, 64.8-75.8) for the D2 + No. 10 group and 64.3% (95% CI, 58.4-70.2; P = .11) for the D2 group, and the 3-year OS in the D2 + No. 10 group was better than that in the D2 group (75.7% [95% CI, 70.6-80.8] vs 66.5% [95% CI, 60.8-72.2]; P = .02). Multivariate analysis revealed that splenic hilar lymphadenectomy was not an independent protective factor for DFS (hazard ratio [HR], 0.86; 95% CI, 0.63-1.16) or OS (HR, 0.81; 95% CI, 0.59-1.12). Stratification analysis showed that patients with advanced posterior gastric cancer in the D2 + No. 10 group had better 3-year DFS (92.9% vs 39.3%; P < .001) and OS (92.9% vs 42.9%; P < .001) than those in the D2 group. Multivariate analysis confirmed that patients with advanced posterior gastric cancer could have the survival benefit from No. 10 lymph node dissection (DFS: HR, 0.10; 95% CI, 0.02-0.46; OS: HR, 0.12; 95% CI, 0.03-0.52). Conclusions and Relevance: Although LSTG could not significantly improve the 3-year DFS of patients with APGC without invasion into the greater curvature, patients with APGC located posterior gastric wall may benefit from LSTG. Trial Registration: ClinicalTrials.gov Identifier: NCT02333721.

Cost-effectiveness analysis of different screening strategies for colorectal cancer in Guangzhou, southern China: a Markov simulation analysis based on natural community screening results.

OBJECTIVES: To evaluate the cost-effectiveness of four different primary screening strategies: high-risk factor questionnaire (HRFQ) alone, single immunochemical faecal occult blood test (iFOBT), double iFOBT and HRFQ+double iFOBT for colorectal cancer (CRC) screening compared with no screening using the Markov model. METHODS: Treeage Pro V.2011 software was used to simulate the Markov model. The incremental cost-effectiveness ratio, which was compared with the willingness-to-pay (WTP) threshold, was used to reflect the cost-effectiveness of the CRC screening method. One-way sensitivity analysis and probabilistic sensitivity analysis were used for parameter uncertainty. RESULTS: All strategies had greater effectiveness because they had more quality-adjusted life years (QALYs) than no screening. When the WTP was ¥435 762/QALY, all screening strategies were cost-effective compared with no screening. The double iFOBT strategy was the best-buy option compared with all other strategies because it had the most QALYs and the least cost. One-way sensitivity analysis showed that the sensitivity of low-risk adenoma, compliance with colonoscopy and primary screening cost were the main influencing factors comparing single iFOBT, double iFOBT and HRFQ+double iFOBT with no screening. However, within the scope of this study, there was no fundamental impact on cost-effectiveness. Probabilistic sensitivity analysis showed that when the WTP was ¥435 762/QALY, the probabilities of the cost-effectiveness acceptability curve with HRFQ alone, single iFOBT, double iFOBT and HRFQ+double iFOBT were 0.0%, 5.3%, 69.3% and 25.4%, respectively. CONCLUSIONS: All screening strategies for CRC were cost-effective compared with no screening strategy. Double iFOBT was the best-buy option compared with all other strategies. The significant influencing factors were the sensitivity of low-risk polyps, compliance with colonoscopy and cost of primary screening.

Patient-Centered Risk Assessment in Implant Treatment Planning.

PURPOSE: To evaluate the current scientific evidence on estimating cumulative risk for biologic complications relating to dental implants and to develop a patient-centered risk assessment tool for establishing aggregate risk. MATERIALS AND METHODS: A review of the scientific literature on risk indicators relating to dental implants was completed with the goal of identifying and weighting individual risk indicators so aggregate biologic risk could be estimated. Three authors completed independent reviews of the literature, identifying 31 systematic reviews on risk indicators for biologic complications with dental implants, from which 24 potential risk indicators were considered. Due to inconclusive scientific data on risk indicators, a Delphi process was used to gather structured expert opinion to supplement findings from the literature. Eleven Delphi participants with expertise in prosthodontics or periodontics participated in two email exchanges and one face-to-face meeting to comment and debate on the initial identification and weighting of risk indicators, propose the addition or removal of risk indicators, and provide recommended clinical management for each risk indicator. RESULTS: After three rounds of debate, literature review, and additions and removals of various risk indicators, consensus (defined as 95% or more in agreement) was achieved on 20 risk indicators. The Delphi group concluded that the risk indicators of smoking, diabetes, antiresorptive agents, and cemented restorations should include subcategories to more accurately identify and represent patient-specific risk. Clinical recommendations based on individual and aggregate risk were established by consensus. CONCLUSION: The literature on risk indicators for biologic complications was conflicting and inconclusive. The Delphi method was used to identify and establish the weighting of individual risk indicators, resulting in a risk assessment tool for estimating aggregate risk.

Willingness to pay for colorectal cancer screening in Guangzhou.

AIM: To measure the willingness to pay for colorectal cancer screening in Guangzhou, and to identify those factors associated with it. METHODS: A face-to-face questionnaire survey for pre-screening population from free and non-free colonoscopy districts was used to collect information on demographic characteristics, health behaviours, the intention of the cancer screenings and willingness to pay for colorectal cancer screening. A total of 1243 participants who took part in the pre-screening for colorectal cancer in Guangzhou were collected in the study. Categorical data were compared using the χ2 test to analyse significant differences. Non-conditional logistic regression and multi-class logistic regression were also performed for multivariate analysis and to estimate the odds ratios. RESULTS: The percentage of participants willing to pay for colorectal cancer screening was 91.7%. "Unnecessary" was the dominant reason that participants gave for their unwillingness, accounting for 63.1%. Of those who were willing to pay, 29.2%, 20.7%, 14.8%, 13.0% and 22.4% of participants were willing to pay less than \100, \100-\199, \200-299, \300-\399 and more than \400, respectively. Non-logistic regression analysis showed that respondents who were male, had a high level of education, were from the family with more children/older to raise, and accepted colorectal cancer screening were willing to pay for this screening. Multi-class logistic regression analysis showed that respondents with higher annual household income per capita, from government and private enterprises, government agency/institution and peasants, and less family medical expenditure were willing to pay more. CONCLUSION: Willingness to pay for colorectal cancer screening in Guangzhou is high, but the amount of willing to pay is not much.

Assessment of usefulness of synchrotron radiation techniques to determine arsenic species in hair and rice grain samples.

The arseniasis in Southwest Guizhou, China has been identified as a unique case of endemic arseniasis caused by exposure to indoor combustion of high As-content coal. Present investigation targeted the microdistribution and speciation of the element arsenic in human hair and environmental samples collected in one of the hyper-endemic villages of arseniasis in the area. Analyses were performed by micro-beam X-ray fluorescence (µ-XRF) and X-ray absorption fine structure (XAFS). The total As level in hair samples of diagnosed patients was detected at almost the same level as in their asymptomatic neighbors. Concentrations in the lateral cut of hair samples were high-low-high (from surface to center). XAFS revealed the coexistence of both the As+3 and As+5 states in hair samples. However, the samples from patients displayed a tendency of higher As+3 / As+5 ratio than the asymptomatic fellow villagers. The µ-XRF mapping of rice grains shows that arsenic penetrates the endosperm, the major edible part of the grain, when rice grains were stored over the open fire of high As-content coal. Synchrotron radiation techniques are suitable to determine arsenic species concentrations in different parts of hair and rice grain samples. As arsenic penetrates the endosperm, rinsing the rice grains with water will remain largely ineffective.

The occurrence of polycyclic aromatic hydrocarbons in Peking duck: Relevance to food safety assessment.

Peking duck is one of the most well-known Chinese dishes. GC-MS analysis revealed that, either benzo(a)pyrene alone, or the total amount of major PAHs with carcinogenic potential for humans, reached levels of 8.7 and 54.7µg/kg, respectively. These levels greatly exceeded those found in grilled poultry in European countries. However, the intake of benzo(a)pyrene from a Peking duck meal (about 0.65µg) was not higher than that from the daily intake (for residents in the same area) from vegetables alone (about 2µg/day). Since Peking duck is still not a plebeian meat in this country, people would not consume it very often.

Discovery and utilization of biocatalysts for chiral synthesis: an overview of Chinese scientists' research and development.

The importance of chiral issues in active pharmaceutical ingredients has been widely recognized not only by pharmacologists, but also by chemists, chemical engineers and administrators. In fact, the worldwide sales of single-enantiomer drugs have exceeded US $150 billion. Among them the contribution rate of biocatalysis technology is ever increasing (up to 15-20%). This chapter will focus on the biocatalytic synthesis of chiral compounds useful for pharmaceutical industry. Diverse enzymes, such as oxidoreductases, epoxide hydrolases, nitrilases/nitrile hydratases and hydroxy nitrile lyases which were isolated from various sources including microorganisms and plants, and the methodology for utilizing these enzymes in enantioselective or asymmetric synthesis will be discussed briefly.

[Assessment of the young rat model of visceral hypersensitivity by measuring electrical discharge of external oblique].

OBJECTIVE: To study the value of measuring electrical discharge of external oblique in assessment of young rat model of visceral hypersensitivity. METHODS: Eight-day-old neonatal Sprague-Dawley rats were randomly assigned to two groups: an experimental group and a control group (n=16 each). Rats in the experimental group were subjected to mechanical colorectal irritation daily for 7 consecutive days, while the rats in the control group did not received colorectal irritation treatment. On the 6th week of their lives, the spike amplitude of external oblique were measured to evaluate the bowel sensitivity. RESULTS: When the colorectal distention (CRD) pressure was 30 and 45 mmHg, the 95% confidence interval of the spike amplitude in the experimental group was significantly higher than that in the control group (P<0.01). When the CRD pressure were 60 and 75 mmHg, the 95% confidence interval of the spike amplitude in female rats was significantly higher than that in males (P<0.05). CONCLUSIONS: The electrical discharge of external oblique confirmed that chronic colorectal irritation in neonatal rats can result in a chronic visceral hypersensitivity in the juvenile stage, with gender differences. Electrophysiological assessment is a quantitative test, and can objectively reflect visceral sensibility of pain.

[Cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: Markov decision analysis].

OBJECTIVE: Using Markov model Monte Carlo simulation to conduct a cost-effectiveness analysis of screening Helicobacter pylori (H. pylori) infection to prevent gastric cancer. METHODS: The Markov model was developed based on the natural course from H. pylori infection to gastric cancer. Two strategies were compared: (1) screening for H. pylori and treatment for those with positive tests, and (2) without screening and treatment. Data used for model simulation including transition probability, efficacy of test and treatment were collected from related research publications. Markov model Monte Carlo simulation combined with bootstrap method was used to perform base-case analysis and estimate the confidence interval of cost-effectiveness ratios. The probability sensitivity analysis was used to estimate the cost-effectiveness in multiple uncertainty factors. RESULTS: Assuming H. pylori eradication will prevent 50% of attribute gastric cancer, the screening strategies would prevent 16.6% cases of gastric cancer. Cost-effectiveness were 10,405 Yuan (95% CI: 4,238 - 27,727 Yuan) per GC prevented, 64 Yuan (95% CI: 31 - 97 Yuan) per QALY saved and 1,374 Yuan (95% CI: 352 - 86,624 Yuan) per life year saved. CONCLUSION: Screening and treatment for H. pylori infection in population was potentially effective in the prevention of gastric cancer, and screening in high incidence area of gastric cancer would be more effective and economic.