Objective： Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis. The aim of this study was to evaluate the role and...Objective： Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis. The aim of this study was to evaluate the role and indications of diagnostic laparoscopy in the detection of intra-abdominal metastasis. Methods： Standard diagnostic laparoscopy with peritoneal cytology examination was performed prospectively on patients who were clinically diagnosed with primary local advanced gastric cancer （CT≥2M0）. We calculated the rate of intra-abdominal metastases identified by diagnostic laparoscopy, and examined the relationship between peritoneal dissemination （P） and cytology results （CY）. Split-sample method was applied to find clinical risk factors for intra-abdominal metastasis. Multivariate logistic regression analysis and receiver-operator characteristic （ROC） analysis were performed in training set to find out risk factors ofintra-abdominal metastasis, and then validate it in testing set. Results： Out of 249 cM0 patients, 51 （20.5%） patients with intra-abdominal metastasis were identified by diagnostic laparoscopy, including 20 （8.0%） P1CY1, 17 （6.8%） POCY1 and 14 （5.6%） P1CY0 patients. In the training set, multivariate logistic regression analysis and ROC analysis showed that the depth of tumor invasion on computer tomography （CT） scan ≥21 mm and tumor-occupied 〉2 portions of stomach are predictive factors of metastasis. In the testing set, when diagnostic laparoscopy was performed on patients who had one or two of these risk factors, the sensitivity and positive predictive value for detecting intra-abdominal metastasis were 90.0% and 32.1%, respectively. Conclusions： According to our results, depth of tumor invasion and tumor-occupied portions of stomach are predictive factors ofintra-abdominal metastasis.展开更多
Objective:This study aims to verify the feasibility and efficacy of laparoscopic lower mediastinal lymphadenectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction(AEG).Setting:An exploratory,observatio...Objective:This study aims to verify the feasibility and efficacy of laparoscopic lower mediastinal lymphadenectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction(AEG).Setting:An exploratory,observational,prospective,cohort study will be carried out under the Idea,Development,Exploration,Assessment and Long-term Follow-up(IDEAL)framework(stage 2 b).Paritcipants:The study will recruit 1,036 patients with cases of locally advanced AEG(Siewert typeⅡ/Ⅲ,clinical stage cT2-4 aN0-3 M0),and 518 will be assigned to either the laparoscopy group or the open group.Interventions:Patients will receive lower mediastinal lymphadenectomy along with either total or proximal gastrectomy.Primary and secondary outcome measures:The primary endpoint is the number of lower mediastinal lymph nodes retrieved,and the secondary endpoints are the surgical safety and prognosis,including intraoperative and postoperative lower-mediastinal-lymphadenectomy-related morbidity and mortality,rate of rehospitalization,R0 resection rate,3-year local recurrence rate,and 3-year overall survival.Conclusions:The study will provide data for the guidance and development of surgical treatment strategies for AEG.Trial registration number:The study has been registered in ClinicalTrials.gov(No.NCT04443478).展开更多
Objective： Infra-pyloric artery （IPA） is an important anatomical landmark in treatment of gastric cancer and is the key vessel for pylorus-preserving gastrectomy and subgroup of infra-pyloric lymph nodes. However, ...Objective： Infra-pyloric artery （IPA） is an important anatomical landmark in treatment of gastric cancer and is the key vessel for pylorus-preserving gastrectomy and subgroup of infra-pyloric lymph nodes. However, its anatomical variation is not thoroughly understood. Our study aimed to clarify the origination of the IPA. Methods： We did this prospective, multicenter, open-label, observational study at gastric surgery departments of 34 hospitals in China. Gastric cancer patients aged 18 years or older and scheduled to undergo elective total or distal gastrectomy were assigned. During the surgery, IPA dissecting and exposing the origination point with photographs or video clips were required. The primary outcome was the origination of the IPA. Analysis of variance, χ2 tests and Fisher＇s tests were used to analyze the differences between groups. The study is registered at Clinicaltrials.gov （No. NCT03071237）. Results： Between May 8 and July 31, 2017, 429 patients were assigned for the study, and 419 （97.7%） patients had the IPA dissected and recorded through photograph or video and were included in the primary outcome analysis. The median age was 62 years old, and 73.7% were male. Among the patients, 78.5% received laparoscopic surgery. Single IPA origination was identified in 398 （95.0%） patients, including gastroduodenal artery （GDA） in 154 （36.8%） patients, anterior superior pancreaticoduodenal artery （ASPDA） in 130 （31.0%） patients, and right gastroepiploic artery （RGEA） in 114 （27.2%） patients. Fifteen （3.6%） patients were identified with multiple IPA and 6 （1.4%） patients were identified as IPA absence. The differences in the distribution of surgical approach （P=0.003） and geographic area （P=0.030） were statistically significant. No difference was shown in sex, age, gastrectomy type, tumor location, and clinical T, N and M stage. Conclusions： Our study found that the IPA originates from GDA, ASPDA and RGEA in similar proportions. Laparoscopic surgery may be more helpful in dissection of the IPA than open surgery.展开更多
Gastric cancer is one of the most common malignancies of the digestive system,and the number of deaths continues to increase.The standardized management of the diagnosis and treatment of gastric cancer is challenging ...Gastric cancer is one of the most common malignancies of the digestive system,and the number of deaths continues to increase.The standardized management of the diagnosis and treatment of gastric cancer is challenging due to the great differences in the diagnosis and treatment of gastric cancer in different regions.The Gastric Cancer Expert Committee of the National Cancer Quality Control Center(NCQCC)identified a lack of authoritative quality control standards as an opportunity to utilize its multidisciplinary membership to improve the standardized diagnosis and treatment of gastric cancer.The Gastric Cancer Expert Committee of the NCQCC aims to promote quality control and national standardization,uniformity,and normalization of gastric cancer diagnosis and treatment,which ultimately improved the survival rate and quality of life of gastric cancer patients.A panel of experts with gastrointestinal cancer surgery,gastrointestinal cancer medicine,medical imaging,pathology and radiotherapy were drawn together and determined the quality control standards for the standardized diagnosis and treatment of gastric cancer.The authors then utilized a modified Delphi approach to generate consensus recommendations.展开更多
Gastrointestinal stromal tumors （GISTs） occur most frequently in the stomach.Diagnosis of gastric GIST is not always clear before surgery.Flexible endoscopy may suggest the nature of the lesion （a bulky tumor with ...Gastrointestinal stromal tumors （GISTs） occur most frequently in the stomach.Diagnosis of gastric GIST is not always clear before surgery.Flexible endoscopy may suggest the nature of the lesion （a bulky tumor with preserved mucosa）; however,biopsy is rarely diagnostic.Therefore,diagnostic medication with safe drugs may provide a feasible way under such conditions after an informed consent is obtained.Based on the excellent efficacy of imatinib mesylate （IM） in the treatment of GIST,we successfully applied it in the diagnostic medication of two patients with clinically suspected gastric stromal tumors.In conclusion,the diagnostic medication with IM can be an alternative option for patients with suspected GIST that can not be confirmed pathologically.展开更多
Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according t...Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.展开更多
Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hos...Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide database.Methods:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018.Hospital volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(>2,500),moderately concentrated(1,500-2,500),and unconcentrated(<1,500).We used mixed-effects models to analyze the data while accounting for data clustering.Results:We analyzed 125,683 patients in 515 institutions.In the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium vs.low:odds ratio(OR)=0.61,95%confidence interval(95%CI)=0.43-0.84,P=0.003;high:OR=0.57,95%CI=0.38-0.87,P=0.009;and very high:OR=0.33,95%CI=0.18-0.61,P<0.001)and length of stay(high vs.low:β=-0.036,95%CI=-0.071--0.002,P=0.039)but not with total cost.Hospitals located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95%CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95%CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated provinces.Conclusions:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost.These results support the strategy of centralizing gastrectomy in high-volume settings.展开更多
Objective: Positive peritoneal lavege cytology(CY1) gastric cancer is featured by dismal prognosis, with high risks of peritoneal metastasis. However, there is a lack of evidence on pathogenic mechanism and signature ...Objective: Positive peritoneal lavege cytology(CY1) gastric cancer is featured by dismal prognosis, with high risks of peritoneal metastasis. However, there is a lack of evidence on pathogenic mechanism and signature of CY1and there is a continuous debate on CY1 therapy. Therefore, exploring the mechanism of CY1 is crucial for treatment strategies and targets for CY1 gastric cancer.Methods: In order to figure out specific driver genes and marker genes of CY1 gastric cancer, and ultimately offer clues for potential marker and risk assessment of CY1, 17 cytology-positive gastric cancer patients and 31matched cytology-negative gastric cancer patients were enrolled in this study. The enrollment criteria were based on the results of diagnostic laparoscopy staging and cytology inspection of exfoliated cells. Whole exome sequencing was then performed on tumor samples to evaluate genomic characterization of cytology-positive gastric cancer.Results: Least absolute shrinkage and selection operator(LASSO) algorithm identified 43 cytology-positive marker genes, while Mut Sig CV identified 42 cytology-positive specific driver genes. CD3G and CDKL2 were both driver and marker genes of CY1. Regarding mutational signatures, driver gene mutation and tumor subclone architecture, no significant differences were observed between CY1 and negative peritoneal lavege cytology(CY0).Conclusions: There might not be distinct differences between CY1 and CY0, and CY1 might represent the progression of CY0 gastric cancer rather than constituting an independent subtype. This genomic analysis will thus provide key molecular insights into CY1, which may have a direct effect on treatment recommendations for CY1and CY0 patients, and provides opportunities for genome-guided clinical trials and drug development.展开更多
In this paper,combined with an actual case project,activity-based costing is used to analyze the labor costs,material costs,and the corresponding indirect costs(such as site management fees and taxes)where each cost i...In this paper,combined with an actual case project,activity-based costing is used to analyze the labor costs,material costs,and the corresponding indirect costs(such as site management fees and taxes)where each cost is analyzed in detailed.Through quantitative comparison,it further determines which business activities are the key cost control objects and proposes targeted implementation plans for actual cost management in the future in order to provide new ideas for improving the implementation efficiency in addition to a reasonable cost control of highway engineering projects.At the same time,through analyzing the situation of highways,different maintenance modes are compared to put forward a more perfect rural road maintenance and management mode.展开更多
Accurate pavement performance prediction plays a critical role in formulating maintenance and repair strategies for transportation departments,enabling the achievement of better pavement performance with limited finan...Accurate pavement performance prediction plays a critical role in formulating maintenance and repair strategies for transportation departments,enabling the achievement of better pavement performance with limited financial resources.However,due to the intricate influence of numerous factors on pavement performance deterioration,improving the accuracy of pavement performance prediction poses a challenge for conventional models.Therefore,the aim of this study is to establish a machine learning-based pavement performance prediction model.First,this study considers five factors that affect pavement performance,including pavement initial performance indicators,traffic loads,weather,pavement structure,and maintenance measures,and identifies 15 specific indicators that affect pavement performance based on these five factors.Then,based on the the long-term pavement performance(LTPP)database,the study screens and summarizes these indicators,obtaining 2464 high-quality pavement performance data for pavement conditions index(PCI)prediction and 3238 high-quality pavement performance data for international roughness index(IRI)prediction.Finally,three distinct prediction models are established,namely,the fully connected neural network(FCNN)model,the long short-term memory(LSTM)model,and the combined LSTM-attention model.The study shows that the LSTM-attention model performs significantly better than the FCNN and LSTM models,with an R2 coefficient of determination of 0.81 for PCI and 0.79 for IRI.The innovation of this paper is that the authors have introduced the attention mechanism on the basic of the LSTM model,which makes the fitting accuracy of the prediction model further improved.展开更多
The existing short-term aging test methods have disadvantages such as not being suitable for high viscosity modified asphalt,independent aging degree,and poor testing convenience.Therefore,this paper investigated and ...The existing short-term aging test methods have disadvantages such as not being suitable for high viscosity modified asphalt,independent aging degree,and poor testing convenience.Therefore,this paper investigated and optimized the aging test conditions of asphalt.The macroscopic rheology and microchemistry of aged asphalt prepared by different aging conditions were comprehensively evaluated.Finally,the most suitable aging test conditions for asphalt were determined by referring to the aging degree of loose asphalt mixture.The experiment results showed that after aging,the rutting factor,carbonyl index,asphaltene content,and creep stiffness of asphalt would increase.The aging degrees of existing asphalt aging methods,i.e.,rolling thin film oven test(RTFOT)and thin film oven test(TFOT),and the corresponding loose asphalt mixtures were quite different,and the difference percentage could reach 86.6%.Based on the TFOT,the asphalt aging conditions were optimized.The aging temperature was 163℃.For 70#and SBS modified asphalt,the recommended asphalt film thickness and aging time were 1.59 mm-85 min and 0.80 mm-85 min,respectively.The aging degree of high viscosity modified asphalt under the condition of 0.80 mm-85 min was close to the aging degree of loose asphalt mixture at 135℃,and the aging degree of 0.80 mm-100 min was close to the aging degree of loose asphalt mixture at 165℃.The proposed aging test conditions can not only accurately simulate the short-term aging behavior of asphalt,but also shorten aging time and save resources.展开更多
Background:Neoadjuvant therapy enhances the possibility of achieving radical resection and improves the prognosis for locally advanced gastric cancer(GC).However,there is a lack of evidence regarding the optimal exten...Background:Neoadjuvant therapy enhances the possibility of achieving radical resection and improves the prognosis for locally advanced gastric cancer(GC).However,there is a lack of evidence regarding the optimal extent of resection for locally advanced proximal GC after neoadjuvant therapy.Methods:In this study,330 patients underwent resection in Peking University Cancer Hospital,with curative intent after neoadjuvant therapy for histologically confirmed proximal GC from January 2009 to December 2022.Results:In this study,45 patients underwent proximal gastrectomy(PG),while 285 underwent total gastrectomy(TG).After propensity-score matching,110 patients(71 TG and 39 PG)were included in the analysis.No significant differences between PG and TG regarding short-term outcomes and long-term prognosis were found.Specifically,PG demonstrated comparable overall survival to TG(P=0.47).Subgroup analysis revealed that although not statistically significant,PG showed a potential advantage over TG in overall survival for patients with tumor-long diameters less than 4 cm(P=0.31).However,for those with a long diameter larger than 4 cm,TG had a better survival probability(P=0.81).No substantial differences were observed in baseline characteristics,surgical safety,postoperative recovery,and postoperative complications.Conclusion:For locally advanced proximal GC with objective response to neoadjuvant therapy(long diameter<4 cm),PG is an alternative surgical procedure.展开更多
Background: Despite the decline in the incidence and mortality rates of gastric cancer (GC), the impact of demographic transition on the global burden of GC remains unclear. The current study aimed to estimate the glo...Background: Despite the decline in the incidence and mortality rates of gastric cancer (GC), the impact of demographic transition on the global burden of GC remains unclear. The current study aimed to estimate the global disease burden through 2040 by age, sex, and region. Methods: GC data for incident cases and deaths by age group and sex were taken from The Global Cancer Observatory (GLOBOCAN) 2020. The incidence and mortality rates were predicted through 2040 by fitting a linear regression model over the most recent trend period with the Cancer Incidence in Five Continents (CI5) data. Results: The global population will grow to 9.19 billion by 2040, accompanied by increasing population ageing. The incidence and mortality rates of GC will show a persistent decrease, with an annual percent change of -0.57% for males and -0.65% for females. East Asia and North America will have the highest and lowest age standardized rates, respectively. A slowdown in the growth of incident cases and deaths will be observed worldwide. The proportion of young and middle-aged individuals will decline, while the percentage of the elderly will increase, and the number of males will be almost twice the number of females. East Asia and high human development index (HDI) regions will be heavily burdened by GC. East Asia had 59.85% of the new cases and 56.23% of deaths in 2020;these will increase to 66.93% and 64.37% by 2040, respectively. The interaction between population growth, the change in ageing structure and the decline in incidence and mortality rates will lead to an increased burden of GC. Conclusions: Ageing and population growth will offset the decline in the incidence and mortality rate of GC, resulting in a substantial increase in the number of new cases and deaths. The age structure will continue to change, especially in high HDI regions, requiring more targeted prevention strategies in the future.展开更多
Background:The incidence of cryptococcal meningitis among immunocompetent patients increases,especially in China and imaging plays an important role.The current study was to find the correlation between magnetic reson...Background:The incidence of cryptococcal meningitis among immunocompetent patients increases,especially in China and imaging plays an important role.The current study was to find the correlation between magnetic resonance imaging (MRI)manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS). Methods:A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study.All the patients had MRI data and clinical data.The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease.Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t-test,Chi-square test,Mann-Whitney test and Spearman rank correlation analysis. Results:In all 65 patients,41 cases (41/65,63.1%;Group 1)had normal immunity and 24 cases (24/65,36.9%;Group 2)had at least one identifiable underlying disease.Fever,higher percentage of neutrophil (NEUT)in white blood cell (WBC),and increased cell number of cerebral spinal fluid (CSF)were much common in patients with underlying disease (Group 1 vs.Group 2:Fever:21/41 vs.21/24,x^2 =8.715,P =0.003;NEUT in WBC:73.15%vs.79.60%,Z=-2.370,P =0.018;cell number of CSF:19 vs.200,Z=-4.298,P <0.001;respectively).Compared to the patients with normal immunity,the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs.Group 2:20/41 vs.20/24,x^2 =7.636,P =0.006).The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r =-0.472,P =0.031,r =0.779,P =0.039;respectively). Conclusions:With the increased number of the involved brain areas in patients with identifiable underlying disease,the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.展开更多
Currently,there is no effective drugs for treating clinically COVID-19 except dexamethasone.We previously revealed that human identical sequences of SARS-CoV-2 promote the COVID-19 progression by upregulating hyaluron...Currently,there is no effective drugs for treating clinically COVID-19 except dexamethasone.We previously revealed that human identical sequences of SARS-CoV-2 promote the COVID-19 progression by upregulating hyaluronic acid(HA).As the inhibitor of HA synthesis,hymecromone is an approved prescription drug used for treating biliary spasm.Here,we aimed to investigate the relation between HA and COVID-19,and evaluate the therapeutic effects of hymecromone on COVID-19.Firstly,HA was closely relevant to clinical parameters,including lymphocytes(n=158;r=−0.50;P<0.0001),C-reactive protein(n=156;r=0.55;P<0.0001),D-dimer(n=154;r=0.38;P<0.0001),and fibrinogen(n=152;r=0.37;P<0.0001),as well as the mass(n=78;r=0.43;P<0.0001)and volume(n=78;r=0.41;P=0.0002)of ground-glass opacity,the mass(n=78;r=0.48;P<0.0001)and volume(n=78;r=0.47;P<0.0001)of consolidation in patient with low level of hyaluronan(HA<48.43 ng/mL).Furthermore,hyaluronan could directly cause mouse pulmonary lesions.Besides,hymecromone remarkably reduced HA via downregulating HAS2/HAS3 expression.Moreover,89%patients with hymecromone treatment had pulmonary lesion absorption while only 42%patients in control group had pulmonary lesion absorption(P<0.0001).In addition,lymphocytes recovered more quickly in hymecromone-treated patients(n=8)than control group(n=5)(P<0.05).These findings suggest that hymecromone is a promising drug for COVID-19 and deserves our further efforts to determine its effect in a larger cohort.展开更多
基金supported by grants supporting the research program of early diagnosis, standardized treatment and therapy effect evaluation of gastric cancer (No. D141100000414004) from Beijing Ministry of Science and Technology
文摘Objective： Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis. The aim of this study was to evaluate the role and indications of diagnostic laparoscopy in the detection of intra-abdominal metastasis. Methods： Standard diagnostic laparoscopy with peritoneal cytology examination was performed prospectively on patients who were clinically diagnosed with primary local advanced gastric cancer （CT≥2M0）. We calculated the rate of intra-abdominal metastases identified by diagnostic laparoscopy, and examined the relationship between peritoneal dissemination （P） and cytology results （CY）. Split-sample method was applied to find clinical risk factors for intra-abdominal metastasis. Multivariate logistic regression analysis and receiver-operator characteristic （ROC） analysis were performed in training set to find out risk factors ofintra-abdominal metastasis, and then validate it in testing set. Results： Out of 249 cM0 patients, 51 （20.5%） patients with intra-abdominal metastasis were identified by diagnostic laparoscopy, including 20 （8.0%） P1CY1, 17 （6.8%） POCY1 and 14 （5.6%） P1CY0 patients. In the training set, multivariate logistic regression analysis and ROC analysis showed that the depth of tumor invasion on computer tomography （CT） scan ≥21 mm and tumor-occupied 〉2 portions of stomach are predictive factors of metastasis. In the testing set, when diagnostic laparoscopy was performed on patients who had one or two of these risk factors, the sensitivity and positive predictive value for detecting intra-abdominal metastasis were 90.0% and 32.1%, respectively. Conclusions： According to our results, depth of tumor invasion and tumor-occupied portions of stomach are predictive factors ofintra-abdominal metastasis.
基金supported by the Chinese Medical Foundation(No.2020064)。
文摘Objective:This study aims to verify the feasibility and efficacy of laparoscopic lower mediastinal lymphadenectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction(AEG).Setting:An exploratory,observational,prospective,cohort study will be carried out under the Idea,Development,Exploration,Assessment and Long-term Follow-up(IDEAL)framework(stage 2 b).Paritcipants:The study will recruit 1,036 patients with cases of locally advanced AEG(Siewert typeⅡ/Ⅲ,clinical stage cT2-4 aN0-3 M0),and 518 will be assigned to either the laparoscopy group or the open group.Interventions:Patients will receive lower mediastinal lymphadenectomy along with either total or proximal gastrectomy.Primary and secondary outcome measures:The primary endpoint is the number of lower mediastinal lymph nodes retrieved,and the secondary endpoints are the surgical safety and prognosis,including intraoperative and postoperative lower-mediastinal-lymphadenectomy-related morbidity and mortality,rate of rehospitalization,R0 resection rate,3-year local recurrence rate,and 3-year overall survival.Conclusions:The study will provide data for the guidance and development of surgical treatment strategies for AEG.Trial registration number:The study has been registered in ClinicalTrials.gov(No.NCT04443478).
基金funded by the Gastric Cancer Diagnose and Treatment Project(D171100006517004,D17110700650000)of Beijing Municipal Science&Technology Commissionsupported by Beijing Municipal Administration of Hospital Clinical Medicine Development of Special Funding Support(ZYLX201701)
文摘Objective： Infra-pyloric artery （IPA） is an important anatomical landmark in treatment of gastric cancer and is the key vessel for pylorus-preserving gastrectomy and subgroup of infra-pyloric lymph nodes. However, its anatomical variation is not thoroughly understood. Our study aimed to clarify the origination of the IPA. Methods： We did this prospective, multicenter, open-label, observational study at gastric surgery departments of 34 hospitals in China. Gastric cancer patients aged 18 years or older and scheduled to undergo elective total or distal gastrectomy were assigned. During the surgery, IPA dissecting and exposing the origination point with photographs or video clips were required. The primary outcome was the origination of the IPA. Analysis of variance, χ2 tests and Fisher＇s tests were used to analyze the differences between groups. The study is registered at Clinicaltrials.gov （No. NCT03071237）. Results： Between May 8 and July 31, 2017, 429 patients were assigned for the study, and 419 （97.7%） patients had the IPA dissected and recorded through photograph or video and were included in the primary outcome analysis. The median age was 62 years old, and 73.7% were male. Among the patients, 78.5% received laparoscopic surgery. Single IPA origination was identified in 398 （95.0%） patients, including gastroduodenal artery （GDA） in 154 （36.8%） patients, anterior superior pancreaticoduodenal artery （ASPDA） in 130 （31.0%） patients, and right gastroepiploic artery （RGEA） in 114 （27.2%） patients. Fifteen （3.6%） patients were identified with multiple IPA and 6 （1.4%） patients were identified as IPA absence. The differences in the distribution of surgical approach （P=0.003） and geographic area （P=0.030） were statistically significant. No difference was shown in sex, age, gastrectomy type, tumor location, and clinical T, N and M stage. Conclusions： Our study found that the IPA originates from GDA, ASPDA and RGEA in similar proportions. Laparoscopic surgery may be more helpful in dissection of the IPA than open surgery.
基金supported by“Beijing Municipal Administration of Hospitals Incubating Program”(No.PX2018043)。
文摘Gastric cancer is one of the most common malignancies of the digestive system,and the number of deaths continues to increase.The standardized management of the diagnosis and treatment of gastric cancer is challenging due to the great differences in the diagnosis and treatment of gastric cancer in different regions.The Gastric Cancer Expert Committee of the National Cancer Quality Control Center(NCQCC)identified a lack of authoritative quality control standards as an opportunity to utilize its multidisciplinary membership to improve the standardized diagnosis and treatment of gastric cancer.The Gastric Cancer Expert Committee of the NCQCC aims to promote quality control and national standardization,uniformity,and normalization of gastric cancer diagnosis and treatment,which ultimately improved the survival rate and quality of life of gastric cancer patients.A panel of experts with gastrointestinal cancer surgery,gastrointestinal cancer medicine,medical imaging,pathology and radiotherapy were drawn together and determined the quality control standards for the standardized diagnosis and treatment of gastric cancer.The authors then utilized a modified Delphi approach to generate consensus recommendations.
基金supported by WU JIEPING Medical Foundation(No.WJP-320.6700.09010)
文摘Gastrointestinal stromal tumors （GISTs） occur most frequently in the stomach.Diagnosis of gastric GIST is not always clear before surgery.Flexible endoscopy may suggest the nature of the lesion （a bulky tumor with preserved mucosa）; however,biopsy is rarely diagnostic.Therefore,diagnostic medication with safe drugs may provide a feasible way under such conditions after an informed consent is obtained.Based on the excellent efficacy of imatinib mesylate （IM） in the treatment of GIST,we successfully applied it in the diagnostic medication of two patients with clinically suspected gastric stromal tumors.In conclusion,the diagnostic medication with IM can be an alternative option for patients with suspected GIST that can not be confirmed pathologically.
基金supportedbyBeijing Municipal Administration of Hospitals(No.DFL20181103)Beijing Hospitals Authority Innovation Studio of Young Staff Funding Support(No.202123).
文摘Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.
基金supported by Beijing Scholar Project 20182024(No.B00033)。
文摘Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide database.Methods:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018.Hospital volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(>2,500),moderately concentrated(1,500-2,500),and unconcentrated(<1,500).We used mixed-effects models to analyze the data while accounting for data clustering.Results:We analyzed 125,683 patients in 515 institutions.In the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium vs.low:odds ratio(OR)=0.61,95%confidence interval(95%CI)=0.43-0.84,P=0.003;high:OR=0.57,95%CI=0.38-0.87,P=0.009;and very high:OR=0.33,95%CI=0.18-0.61,P<0.001)and length of stay(high vs.low:β=-0.036,95%CI=-0.071--0.002,P=0.039)but not with total cost.Hospitals located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95%CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95%CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated provinces.Conclusions:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost.These results support the strategy of centralizing gastrectomy in high-volume settings.
基金supported by the National Natural Science Foundation of China (No. U20A20371)the National Key Technology Research and Development Program of the Ministry of Science and Technology of China (No. D171100006517004)+2 种基金Beijing Municipal Administration of Hospitals’ Youth Program (QML20191103)Clinical Medicine Plus X-Young Scholars Project, Peking Universitythe Fundamental Research Funds for the Central Universities and the Science Foundation of Peking University Cancer Hospital。
文摘Objective: Positive peritoneal lavege cytology(CY1) gastric cancer is featured by dismal prognosis, with high risks of peritoneal metastasis. However, there is a lack of evidence on pathogenic mechanism and signature of CY1and there is a continuous debate on CY1 therapy. Therefore, exploring the mechanism of CY1 is crucial for treatment strategies and targets for CY1 gastric cancer.Methods: In order to figure out specific driver genes and marker genes of CY1 gastric cancer, and ultimately offer clues for potential marker and risk assessment of CY1, 17 cytology-positive gastric cancer patients and 31matched cytology-negative gastric cancer patients were enrolled in this study. The enrollment criteria were based on the results of diagnostic laparoscopy staging and cytology inspection of exfoliated cells. Whole exome sequencing was then performed on tumor samples to evaluate genomic characterization of cytology-positive gastric cancer.Results: Least absolute shrinkage and selection operator(LASSO) algorithm identified 43 cytology-positive marker genes, while Mut Sig CV identified 42 cytology-positive specific driver genes. CD3G and CDKL2 were both driver and marker genes of CY1. Regarding mutational signatures, driver gene mutation and tumor subclone architecture, no significant differences were observed between CY1 and negative peritoneal lavege cytology(CY0).Conclusions: There might not be distinct differences between CY1 and CY0, and CY1 might represent the progression of CY0 gastric cancer rather than constituting an independent subtype. This genomic analysis will thus provide key molecular insights into CY1, which may have a direct effect on treatment recommendations for CY1and CY0 patients, and provides opportunities for genome-guided clinical trials and drug development.
文摘In this paper,combined with an actual case project,activity-based costing is used to analyze the labor costs,material costs,and the corresponding indirect costs(such as site management fees and taxes)where each cost is analyzed in detailed.Through quantitative comparison,it further determines which business activities are the key cost control objects and proposes targeted implementation plans for actual cost management in the future in order to provide new ideas for improving the implementation efficiency in addition to a reasonable cost control of highway engineering projects.At the same time,through analyzing the situation of highways,different maintenance modes are compared to put forward a more perfect rural road maintenance and management mode.
基金supported by the Science and Technology Plan of Shandong Transportation Department(No.2021B47)the Key Research and Development Program of Ningxia Science and Technology Department(No.2022BEG02008)the Fundamental Research Funds for the Central Universities(No.22120210027).
文摘Accurate pavement performance prediction plays a critical role in formulating maintenance and repair strategies for transportation departments,enabling the achievement of better pavement performance with limited financial resources.However,due to the intricate influence of numerous factors on pavement performance deterioration,improving the accuracy of pavement performance prediction poses a challenge for conventional models.Therefore,the aim of this study is to establish a machine learning-based pavement performance prediction model.First,this study considers five factors that affect pavement performance,including pavement initial performance indicators,traffic loads,weather,pavement structure,and maintenance measures,and identifies 15 specific indicators that affect pavement performance based on these five factors.Then,based on the the long-term pavement performance(LTPP)database,the study screens and summarizes these indicators,obtaining 2464 high-quality pavement performance data for pavement conditions index(PCI)prediction and 3238 high-quality pavement performance data for international roughness index(IRI)prediction.Finally,three distinct prediction models are established,namely,the fully connected neural network(FCNN)model,the long short-term memory(LSTM)model,and the combined LSTM-attention model.The study shows that the LSTM-attention model performs significantly better than the FCNN and LSTM models,with an R2 coefficient of determination of 0.81 for PCI and 0.79 for IRI.The innovation of this paper is that the authors have introduced the attention mechanism on the basic of the LSTM model,which makes the fitting accuracy of the prediction model further improved.
基金suppoted by the National Key R&D Program of China(No.2023YFB2604000)the Transportation Science and Technology Project of Henan Province(No.2022-56)the Key Research and Development Program of Ningxia Science and Technology Department(No.2022BEG02008).
文摘The existing short-term aging test methods have disadvantages such as not being suitable for high viscosity modified asphalt,independent aging degree,and poor testing convenience.Therefore,this paper investigated and optimized the aging test conditions of asphalt.The macroscopic rheology and microchemistry of aged asphalt prepared by different aging conditions were comprehensively evaluated.Finally,the most suitable aging test conditions for asphalt were determined by referring to the aging degree of loose asphalt mixture.The experiment results showed that after aging,the rutting factor,carbonyl index,asphaltene content,and creep stiffness of asphalt would increase.The aging degrees of existing asphalt aging methods,i.e.,rolling thin film oven test(RTFOT)and thin film oven test(TFOT),and the corresponding loose asphalt mixtures were quite different,and the difference percentage could reach 86.6%.Based on the TFOT,the asphalt aging conditions were optimized.The aging temperature was 163℃.For 70#and SBS modified asphalt,the recommended asphalt film thickness and aging time were 1.59 mm-85 min and 0.80 mm-85 min,respectively.The aging degree of high viscosity modified asphalt under the condition of 0.80 mm-85 min was close to the aging degree of loose asphalt mixture at 135℃,and the aging degree of 0.80 mm-100 min was close to the aging degree of loose asphalt mixture at 165℃.The proposed aging test conditions can not only accurately simulate the short-term aging behavior of asphalt,but also shorten aging time and save resources.
基金supported by grants from Joint Fund of National Natural Science Foundation of China(No.U20A20371)Clinical Medicine Plus X-Young Scholars Project,Peking University,the Fundamental Research Funds for the Central Universities and the Science Foundation of Peking University Cancer Hospital(to Zhouqiao Wu),and Incubating Program of Haidian District(No.HP2023-19-503001).
文摘Background:Neoadjuvant therapy enhances the possibility of achieving radical resection and improves the prognosis for locally advanced gastric cancer(GC).However,there is a lack of evidence regarding the optimal extent of resection for locally advanced proximal GC after neoadjuvant therapy.Methods:In this study,330 patients underwent resection in Peking University Cancer Hospital,with curative intent after neoadjuvant therapy for histologically confirmed proximal GC from January 2009 to December 2022.Results:In this study,45 patients underwent proximal gastrectomy(PG),while 285 underwent total gastrectomy(TG).After propensity-score matching,110 patients(71 TG and 39 PG)were included in the analysis.No significant differences between PG and TG regarding short-term outcomes and long-term prognosis were found.Specifically,PG demonstrated comparable overall survival to TG(P=0.47).Subgroup analysis revealed that although not statistically significant,PG showed a potential advantage over TG in overall survival for patients with tumor-long diameters less than 4 cm(P=0.31).However,for those with a long diameter larger than 4 cm,TG had a better survival probability(P=0.81).No substantial differences were observed in baseline characteristics,surgical safety,postoperative recovery,and postoperative complications.Conclusion:For locally advanced proximal GC with objective response to neoadjuvant therapy(long diameter<4 cm),PG is an alternative surgical procedure.
基金supported by a grant from the Summit Talent Plan of Beijing Hospitals Authority(No.DFL20181103).
文摘Background: Despite the decline in the incidence and mortality rates of gastric cancer (GC), the impact of demographic transition on the global burden of GC remains unclear. The current study aimed to estimate the global disease burden through 2040 by age, sex, and region. Methods: GC data for incident cases and deaths by age group and sex were taken from The Global Cancer Observatory (GLOBOCAN) 2020. The incidence and mortality rates were predicted through 2040 by fitting a linear regression model over the most recent trend period with the Cancer Incidence in Five Continents (CI5) data. Results: The global population will grow to 9.19 billion by 2040, accompanied by increasing population ageing. The incidence and mortality rates of GC will show a persistent decrease, with an annual percent change of -0.57% for males and -0.65% for females. East Asia and North America will have the highest and lowest age standardized rates, respectively. A slowdown in the growth of incident cases and deaths will be observed worldwide. The proportion of young and middle-aged individuals will decline, while the percentage of the elderly will increase, and the number of males will be almost twice the number of females. East Asia and high human development index (HDI) regions will be heavily burdened by GC. East Asia had 59.85% of the new cases and 56.23% of deaths in 2020;these will increase to 66.93% and 64.37% by 2040, respectively. The interaction between population growth, the change in ageing structure and the decline in incidence and mortality rates will lead to an increased burden of GC. Conclusions: Ageing and population growth will offset the decline in the incidence and mortality rate of GC, resulting in a substantial increase in the number of new cases and deaths. The age structure will continue to change, especially in high HDI regions, requiring more targeted prevention strategies in the future.
文摘Background:The incidence of cryptococcal meningitis among immunocompetent patients increases,especially in China and imaging plays an important role.The current study was to find the correlation between magnetic resonance imaging (MRI)manifestation and clinical severity in nonhuman immunodeficiency virus patients with cryptococcal infection of central nervous system (CNS). Methods:A total of 65 patients with CNS cryptococcal infection from August 2014 to October 2016 were retrospectively included in this study.All the patients had MRI data and clinical data.The patients were divided into two groups according to whether the patients were confirmed with identifiable underlying disease.Comparison and correlation of MRI and clinical data in both groups were investigated using independent sample t-test,Chi-square test,Mann-Whitney test and Spearman rank correlation analysis. Results:In all 65 patients,41 cases (41/65,63.1%;Group 1)had normal immunity and 24 cases (24/65,36.9%;Group 2)had at least one identifiable underlying disease.Fever,higher percentage of neutrophil (NEUT)in white blood cell (WBC),and increased cell number of cerebral spinal fluid (CSF)were much common in patients with underlying disease (Group 1 vs.Group 2:Fever:21/41 vs.21/24,x^2 =8.715,P =0.003;NEUT in WBC:73.15%vs.79.60%,Z=-2.370,P =0.018;cell number of CSF:19 vs.200,Z=-4.298,P <0.001;respectively).Compared to the patients with normal immunity,the lesions are more common in the basal ganglia among patients with identifiable underlying disease (Group 1 vs.Group 2:20/41 vs.20/24,x^2 =7.636,P =0.006).The number of the involved brain areas in patients with identifiable underlying disease were well correlated with the number of cells and pressure of CSF (r =-0.472,P =0.031,r =0.779,P =0.039;respectively). Conclusions:With the increased number of the involved brain areas in patients with identifiable underlying disease,the body has lower immunity against the organism which might result in higher intracranial pressure and more severe clinical status.
基金the National Key R&D Program of China(2018YFC1005004)Major Special Projects of Basic Research of Shanghai Science and Technology Commission(18JC1411101)+1 种基金National Natural Science Foundation of China(31872814,32000505)Shanghai Science and Technology Innovation Action Plan,Medical Innovation Research Special Project(20Z11900900).
文摘Currently,there is no effective drugs for treating clinically COVID-19 except dexamethasone.We previously revealed that human identical sequences of SARS-CoV-2 promote the COVID-19 progression by upregulating hyaluronic acid(HA).As the inhibitor of HA synthesis,hymecromone is an approved prescription drug used for treating biliary spasm.Here,we aimed to investigate the relation between HA and COVID-19,and evaluate the therapeutic effects of hymecromone on COVID-19.Firstly,HA was closely relevant to clinical parameters,including lymphocytes(n=158;r=−0.50;P<0.0001),C-reactive protein(n=156;r=0.55;P<0.0001),D-dimer(n=154;r=0.38;P<0.0001),and fibrinogen(n=152;r=0.37;P<0.0001),as well as the mass(n=78;r=0.43;P<0.0001)and volume(n=78;r=0.41;P=0.0002)of ground-glass opacity,the mass(n=78;r=0.48;P<0.0001)and volume(n=78;r=0.47;P<0.0001)of consolidation in patient with low level of hyaluronan(HA<48.43 ng/mL).Furthermore,hyaluronan could directly cause mouse pulmonary lesions.Besides,hymecromone remarkably reduced HA via downregulating HAS2/HAS3 expression.Moreover,89%patients with hymecromone treatment had pulmonary lesion absorption while only 42%patients in control group had pulmonary lesion absorption(P<0.0001).In addition,lymphocytes recovered more quickly in hymecromone-treated patients(n=8)than control group(n=5)(P<0.05).These findings suggest that hymecromone is a promising drug for COVID-19 and deserves our further efforts to determine its effect in a larger cohort.
