Short-term outcomes and long-term quality of life after undergoing radical proximal gastrectomy with esophageal gastric tube anastomosis and total gastrectomy with Roux-en-Y anastomosis for Siewert type II and III adenocarcinoma of the esophagogastric junction: A propensity score matching analysis / 中华胃肠外科杂志

Objective: To evaluate the effects on short-term clinical outcomes and long-term quality of life of laparoscopic-assisted radical proximal gastrectomy with esophageal gastric tube anastomosis versus total gastrectomy with Roux-en-Y anastomosis for adenocarcinoma of the esophagogastric junction. Methods: This was a propensity score matching, retrospective, cohort study. Clinicopathological data of 184 patients with adenocarcinoma of the esophagogastric junction admitted to two medical centers in China from January 2016 to January 2021 were collected (147 in the First Affiliated Hospital of Xiamen University and 37 in the Affiliated Hospital of Qinghai University). All patients had undergone laparoscopic-assisted radical gastrectomy. They were divided into two groups based on the extent of tumor resection and technique used for digestive tract reconstruction. A proximal gastrectomy with reconstruction by esophageal gastric tube anastomosis group comprised 82 patients and a total gastrectomy with reconstruction by Roux-en-Y anastomosis group comprised 102 patients. These groups differed significantly in the following baseline characteristics: age, preoperative hemoglobin, preoperative albumin, tumor length, tumor differentiation, and tumor TNM stage (all P<0.05). To eliminate potential bias caused by unequal distribution between the two groups, 1∶1 matching was performed by the nearest neighbor matching method. The 13 matched variables comprised sex, age, height, body mass, body mass index, preoperative glucose, preoperative hemoglobin, preoperative total protein, preoperative albumin, neoadjuvant radiotherapy, tumor length, degree of differentiation, and pathological TNM stage. Postoperative complications, postoperative nutritional status, incidence of reflux esophagitis 1 year after surgery, and quality of life were compared between the two groups. Results: After propensity score matching, 60 patients each were enrolled in the proximal gastrectomy with esophageal gastric tube anastomosis and total gastrectomy with Roux-en-Y anastomosis groups. The baseline characteristics were comparable between these groups (all P>0.05). There were no significant differences between the two groups in operative time, intraoperative bleeding, time to semifluid diet, postoperative hospital days, tumor length, and total hospital costs (P>0.05). Patients in the proximal gastrectomy with esophageal gastric tube anastomosis group had earlier postoperative gastric tube and abdominal drainage tube removal time than those in the total gastrectomy with Roux-en-Y anastomosis group (t=-2.183, P=0.023 and t=-4.073, P<0.001, respectively). In contrast, significantly fewer lymph nodes were cleared and significantly fewer lymph nodes were positive in the proximal gastrectomy with esophageal gastric tube anastomosis group than in the total gastrectomy with Roux-en-Y anastomosis group (t=-5.754, P<0.001 and t=-2.575, P=0.031, respectively). The incidence of early postoperative complications was 43.3% (26/60) in the total gastrectomy with Roux-en-Y anastomosis group; this is not significantly higher than the 26.7% (16/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group (χ2=3.663，P=0.056). The incidences of pulmonary infection (31.7%, 19/60) and pleural effusion (30.0%, 18/60) were significantly higher in the total gastrectomy with Roux-en-Y anastomosis group than in the proximal gastrectomy with esophageal gastric tube anastomosis group (13.3%, 8/60 and 8.3%, 5/60, respectively); these differences are significant (χ2=8.711, P=0.003 and χ2=11.368, P=0.001, respectively). All early complications were successfully treated before discharge. The incidence of long-term postoperative complications was 20.0% (12/60) in the total gastrectomy with Roux-en-Y anastomosis group and 35.0% (21/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group; this difference is not significant (χ2=3.386，P=0.066). The incidence of reflux esophagitis was 23.3% (14/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group; this is significantly higher than the 1.7% (1/60) in the total gastrectomy with Roux-en-Y anastomosis group (χ2=12.876, P<0.001). Body mass index had decreased significantly in both groups 1 year after surgery compared with preoperatively; however, the difference between the two groups was not significant (P>0.05). The differences in hemoglobin and albumin concentrations between 1 year postoperatively and preoperatively were not significant (both P>0.05). Quality of life was assessed using the Visick grade. Visick grade I dominated in both groups. The percentage of patients with Visick II and III in the total gastrectomy with Roux-en-Y anastomosis group was 11.7% (7/60), which is significantly lower than the 33.3% (20/60) in the proximal gastrectomy with esophageal gastric tube anastomosis group (χ2=8.076, P=0.004). No patients in either group had a grade IV quality of life. Conclusions: Both proximal gastrectomy with esophageal gastric tube anastomosis and total gastrectomy with Roux-en-Y anastomosis laparoscopic-assisted radical surgery for adenocarcinoma of the esophagogastric junction are safe and feasible. However, both procedures have their own advantages and disadvantages in terms of postoperative complications. The incidence of reflux esophagitis is higher after proximal gastrectomy with esophageal gastric tube anastomosis, whereas the long-term quality of life is lower than that of patients after total gastrectomy with Roux-en-Y anastomosis.

Perirectal fascial anatomy and pelvic autonomic nerve preservation during the transanal total mesorectal excision / 中华胃肠外科杂志

The difficulty of transanal total mesorectal excision (TME) is to find the correct dissection plane of perirectal space. As a complex new surgical procedure, the fascial anatomic landmarks of transanal approach operation are more likely to be ignored. It is often found that dissection plane is false after the secondary injury occurs during the operation, which results in the damage of pelvic autonomic nerves. Meanwhile, the mesorectum is easily damaged if the dissection plane is too close to the rectum. Thus, the safety of oncologic outcomes could be limited by difficulty achieving adequate TME quality. The promotion and development of the theory of perirectal fascial anatomy provides a new thought for researchers to design a precise approach for transanal endoscopic surgery. Transanal total mesorectal excision based on fascial anatomy offers a solution to identify the transanal anatomic landmarks precisely and achieves pelvic autonomic nerve preservation. In this paper, the authors focus on the surgical experience of transanal total mesorectal excision based on the theory of perirectal fascial anatomy, and discuss the feature of perirectal fascial anatomy dissection and technique of pelvic autonomic nerve preservation during transanal approach operation.

Investigation of iodine nutritional status of children in Xiaodeng island of Xiamen Fujian provence in 2010 / 中国地方病学杂志

Objective To find out the iodine nutritional status of children in Xiamen island, and to provide the scientific basis for iodine supplimentation. Methods On March 2010, thyroids of all children aged 6to 12, from primary school on the Xiaodeng island of Xiamen were examined by palpation, urinary iodine, iodine content of salt athome and IQ level were tested, and were collected 20 households, iodine content of drinking water was tested randomly. Results IQ testing and thyroid palpation were carried out among a total of 156 children, the goiter rate of children was 1.28% (2/156), the mean IQ was 110; 154 urine samples were taken, the median urinary iodine was 219.1 μg/L; a total of 153 salt samples were tested, and the qualified rate of iodized salt was 87.58%(134/153), and the mean iodine content in the tap water was 4.52 μg/L Conclusions Iodine nutritional status of the island residents is better, and there are no such problems as excessive iodine.

Analysis of iodine nutritional status of high-risk population in coastal salt-producing areas and coastal nonsalt-producing areas in Xiamen city of Fujian province / 中国地方病学杂志

Objective To assess the iodine nutritional status of special target population in coastal saltproducing areas and coastal non-salt-producing areas in Xiamen city,and to provide a basis for take appropriate measures for prevention of iodine deficiency disorders.Methods The Xiang-An salt-producing areas and the JiMei non-salt-producing areas were chosen as research spots in 2009.One sample of produced water and 2 samples of tap water were collected to test iodine level; 600 children aged 8 to 10 were selected and thyroid palpation was performed,besides,the urine sample and household salt sample were also collected for iodine determination.Sixty pregnant women,breasffeeding women,and 0 - 2 year old infants were recruited,respectively,and urine samples and household salt samples were collected to perform the determination of iodine level.Results The iodine levels in drinking water of Xiang-An district and Ji-Mei district were 3.23 and 6.05 mg/L,respectively.The consumption rates of edible qualified iodinated salt were 84.4％ (438/519) and 98.3％ (392/399),respectively.The goiter rates of children aged 8 - 10 were 3.03％(19/628) and 0.67％(4/600),respectively.The medians of urinary iodine were 202.80 and 238.40 μg/L,respectively.The proportions of urinary iodine level ＜ 50 μg/L were 3.5％ (14/405) and 1.0％(2/202),respectively.The medians of urinary iodine of the pregnant women were 120.55 and 153.35 μg/L,respectively,and the proportions of urinary iodine level ＜ 150 μg/L were 62.1％ (46/74) and 46.8％ (29/62),respectively.The medians of urinary iodine in three trimester were 173.10,144.75 and 101.90 μg/L,respectively,early trimester of pregnancy ＞ second trimester and third trimester (Z =6.151,3.052,all P ＜ 0.05),second trimester ＞ third trimester (Z =2.016,P ＜ 0.05 ).The medians of urinary iodine of the breastfeeding women were 131.20 and 104.35 μg/L,respectively.The proportions of urinary iodine level ＜ 100 μg/L were 35.3％ (24/68) and 46.7％(28/60),respectively.The medians of urinary iodine of the infants were 81.95 and 80.20 μg/L,respectively,the proportions of urinary iodine level ＜ 100 μg/L were 59.7％(37/62) and 61.6％(40/65),respectively,＜ 50 μg/L were 32.3％ (20/62) and 30.8％ (20/65),respectively.Conclusions The levels of iodine nutrition in pregnant women,breastfeeding women,and 0 - 2 year old infants from Xiang-An district and Ji-Mei district in Xiamen city are still below the desired level of iodine nutrition,and the infants and pregnant women in coastal salt-producing areas are poor in iodine nutrition,we should pay close attention.We should strengthen market supervision on iodized salt,carried out iodine nutrition monitoring on pregnant women,breasffeeding women,and infants,and disseminate knowledge of iodine nutrition among high-risk population should be carried out immediately.

Epidemiological investigation of the village with iodine in drinking water on Qianbian village and the adjacent villages in Xiamen city,Fujian province in 2008 / 中国地方病学杂志

Objective To investigate the current conditions of water iodine,childrens'iodine nutrition and residents'edible circumstance of iodized salt in the villages with high iodine in drinking water and the adjacent three villages in Xiamen city of Fujian province.Methods Four natural villages of Qianbian,Donglian,Dazhong and Dongshan of Xiangan county were chosen as survey spots in 2008.In each village,one running water sample and all well water samples were collected to obtain the benchmark for each location.All children aged 7-13 year in the four villages underwent thyroid palpation and were selected to measure the urine iodine and the salt iodine.The water iodine and urine iodine were determined by As3+-Ce4+ catalytic spectrophotometry digestion,salt iodine was determined by direct titration.Results In four investigated villages,iodine of four running water samples were all 1.5μg/L.The range of 237 well water iodine samples was from 0.1 μg/L to 506.0 μg/L.There were 18.6% (44/237)specimens in which the well water iodine less than 10 μg/L,73.4%(174/237)between 10 μg/L and 150 μg/L and 8%(19/237)more than 150μg/L.The median of urinary iodine was 153.3 μg/L in 79 urine samples,which was 114%(9/79)more than 200μg/L and less than 300μg/L,12.7%(10/79)equal or more than 300 μg/L and less than 500μg/L,7.6%(6/79)equal or more than 500μg/L and less than 800 μg/L in all samples.Seventy-nine students were examined by palpation and the total goiter rate of children measured was 11.4% (9/79).Seventy-one samples of iodine salt were detected and the coverage rate of iodized salt was 77.5%(55/71).Conclusions The well water iodine contents have a wide distribution in the investigated villages.We should enhance the community awareness by educating them on the damage of iodine excess and iodine deficiency.

Experimental study of tissue-engineered skin loaded with keratinocyte growth factor nanocapsules for skin defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the effect of tissue-engineered skin loaded with keratinocyte growth factor (KGF) nanocapsules for skin defect on athymic mice.</p><p><b>METHODS</b>The acellular dermal matrix (ADM) loaded with KGF-ADM was constructed by means of phacoemulsification solvent evaporation and low temperature drying. The human epidermal stem cells and fibroblasts were captured and identified, then cultivated on the surface of the KGF-ADM. The cell growth was observed. The tissue-engineered skin without KGF was used as sham group. The autogenous skin graft was used as control group. 2 and 6 weeks after the skin was transplanted to the back of athymic mice, the contraction and histological healing of the transplanted skins were observed respectively. Then the immunofluorescence examination with anti-human K10-FITC and beta1-integrin-Cy3 were applied to detect the origin, growth and differentiation of epidermal and dermal cells in tissue-engineered skin.</p><p><b>RESULTS</b>The epidermal stem cells grew well and attached tightly on KGF-ADM. There were small round stem cells and polygonal terminally-differentiated cells, which appeared a partly cloning growth and a tendency of merging. The tissue-engineered skin with KGF nanocapsules gained better result in repairing the skin defects as compared with the blank group and the control group 2 and 6 weeks after transplantation. The regenerative skin cells could connect and mix closely with the athymic mouse skin cells on the border of skin defect. Meanwhile, the regenerative skin existed some contraction. The histological observation with HE staining showed that the regenerative skin possessed intact epidermis with several cell layers and normal keratose stratum, among which there were still some beta1-integrin (+) cells which represented epidermal stem cells or transient amplifying cells when they were tested by immunofluorescence after 6 weeks of transplantation.</p><p><b>CONCLUSIONS</b>The tissue-engineered skin loaded with KGF nanocapsules had a better result in repairing athymic mice skin defects than common tissue-engineered skin without KGF nanocapsules or skin auto-graft.</p>