Volume 102 ·  Issue 12 ·  2022

The “Metastasis type V”, “Envelope” theory and other concepts have been proposed to make gastric surgeons have a full understanding of the importance of mesogastrium, and the correct identification of the boundary of the mesogastrium is the premise of the complete mesogastrium excision(CME), and also the best way to achieve truly standardized D2 lymph node dissection for gastric cancer. In this paper, the boundary of the mesogastrium during complete mesogastrium excision for gastric cancer and how to achieve this operation in practice were studied, which help gastric surgeons finally find the mesogastrium tissue distributed throughout the gastric cancer surgery to achieve the best surgical treatment effect.

As an independent disease, aplastic anemia (AA) has been recognized for more than a century. When AA is diagnosed, other non-AA bone marrow failures should be excluded. It is termed as exclusive diagnosis of AA. The exclusive diagnosis of AA is helplessly based on that there is no parameter by which AA can be sensitively and specifically diagnosed now. So further searching for the meaningful diagnostic parameters of AA should be carried on to establish a direct diagnostic protocol of this disease and make it possible to differentiate it clearly from other bone marrow failure disease such as congenenital bone marrow failure, hypoplastic myelodysplastic syndromes, AA-paroxysmal nocturnal hemoglobinuria syndromes, large granules lymphocyte leukemia, clonal cytopenia of undetermined significance, immunorelated pancytopenia, acute hemopoietic arresting and idiopathic cytopenia of undetermined significance. The new markers and technologies being helpful for distinguishing AA from other bone marrow failures should be used in diagnosing AA. Correct understanding and application of exclusive diagnosis is not only related to the correctness of diagnosis and treatment of excluded diseases, but also to the quality of AA diagnosis, treatment and research.

With the explosive growth of deep learning and big data technology, artificial intelligence has penetrated into various fields of medical and health care, bringing efficient and high-quality health services to patients, but also a series of ethical and social governance issues have emerged. In order to avoid and eliminate the foreseeable ethical risks and governance challenges in the development of medical artificial intelligence, the World Health Organization (WHO) first released the Ethical and Governance of Artificial Intelligence for Health guidance on June 28, 2021, aimed to provide a framework for ethical guidelines on the deployment of artificial intelligence in clinical practice. At present, there are still shortcomings and this paper takes Healthy China 2030 agenda and the WHO guidelines as strategic ideas, and proposes to shape a consensus on the ethics of medical artificial intelligence, establish rules for human subjects and ownership of responsibilities, improve the legal and regulatory system, and determine human decision-making and moral subject status, taking into account the cultivation of interdisciplinary talents' ethical literacy and other Chinese inspirations are expected to promote the development of medical artificial intelligence ethics governance.

The aging process of China's population is deepening, and the elderly have prominent health problems such as declining physical health level, declining physiological function, malnutrition and the coexistence of multiple diseases, which brings a series of challenges to the construction of China's public health system and the construction of an aged-friendly society. In order to actively respond to the challenges, after full discussion by experts, the following initiatives were formed and launched: the government needs to do a good job in top-level design and system construction, speed up the construction of an aged-friendly environment, and integrate the health needs of the elderly into epidemic prevention and control strategies; Encourage society to invest in the construction of old-age care and care institutions, and encourage enterprises, scientific research institutes and colleges and universities to strengthen industry-university-research cooperation; At the family level, we should master the knowledge and skills of first aid, adhere to good hygiene habits, care for and respect the elderly; The elderly need to establish their own active health outlook, grasp the changes of health status and physical functions, get sufficient nutrition through diet, maintain regular and moderate physical activities, use drugs safely, reasonably and standardizedly, enhance the awareness of vaccination to prevent diseases, and actively participate in and integrate into society. All levels of government, society, family and individuals work together to strengthen the health protection of the elderly and achieve healthy aging.

Through bioinformatics analysis to screen key immune-related genes (IRGs) and cancer-related pathways in gastric adenocarcinoma (GAC) therapy, combining immune cell microenvironment to predict the prognosis of GAC.

RNA sequencing and clinical data were obtained from public databases. Differentially expressed IRGs between GAC and normal tissues were identified by integrated bioinformatics analysis. Univariate and multivariate Cox regression analyses were applied to screen survival-associated IRGs. Then, we established the risk signature model and found another database for external validation. In addition, we explored the relationship with the immune cell microenvironment in each GAC sample using CIBERSORT algorithms.

A total of 78 differentially expressed IRGs were screened, including 47 up-regulated and 31 down-regulated genes. Subsequently, a five-IRGs signature (BMP8A、MMP12、NRG4、S100A9 and TUBB3) was significantly associated with the overall survival of GAC patients. Survival analysis indicated that patients in the high-risk group have a poor prognosis. The results of the multivariate analysis revealed that the risk score was an independent prognostic factor. Further analysis showed that the prognostic model had excellent predictive performance in both TCGA and GEO validated cohorts. Besides, the results of tumor-infiltrating immune cell analysis indicated that the risk score could reflect the status of the tumor immune microenvironment.

BMP8A, MMP12, NRG4, S100A9 and TUBB3 with the risk signature model are associated with prognosis in patients with GAC, combined with tumor-infiltrating immune cells to provide new markers for immunotherapy in GAC.

To investigate the effect of enhanced recovery after surgery on the stress response of gastric cancer patients complicated with type 2 diabetes mellitus.

We retrospectively analyzed the data of 49 patients with type 2 diabetes who underwent radical gastrectomy for gastric cancer in the Department of gastroenterology of the Affiliated Hospital of Jiangsu University from Jan to Dec 2020. They were randomly divided into experimental group and control group according to different perioperative management measures. The perioperative C-reactive protein (CRP), white blood cell (WBC), interleukin-6(IL-6), insulin resistance (HOMA-IR), blood glucose fluctuation and postoperative recovery were compared between the two groups.

A total of 49 patients were enrolled in the study (23 in the experimental group and 26 in the control group). The degree of stress reaction of the experimental group was lighter than that of the control group. The levels of CRP were significantly different on the 5th and 7th day after operation, IL-6 was significantly different on the 1st, 3rd, 5th and 7th day after operation, WBC and HOMA-IR were significantly different on the 1st day postoperatively. And the changes of HOMA-IR and blood glucose in experimental group were more gentle than those in control group. All the differences were statistically significant(P<0.05). In the experimental group, the time of first anal exhaust, indwelling time of drainage tube or nasointestinal tube and the total hospitalization time were significantly shorter than those of the control group(P<0.05).

ERAS can reduce the degree of inflammatory stress and the postoperative IR level promote the early recovery of patients with gastric cancer complicated with type 2 diabetes mellitus.

To investigate the role of operative link on gastritis assessment (OLGA) staging system in risk assessment of gastric precancerous states and precancerous lesions.

A total of 682 patients undergoing gastroscopy from January to July 2016 at the First Hospital of Jiaxing were enrolled. According to the results of gastroscopy and pathology, patients were divided into five groups by OLGA staging system, respectively. The differences of atrophic progression/reversion rate, detection rates of intraepithelial neoplasia and gastric cancer among different OLGA groups during 5-year follow-up were compared.

A total of 437 patients completed endoscopic follow-up, including 207 cases in Stage-0, 158 cases in Stage-Ⅰ, 47 cases in Stage-Ⅱ, 18 cases in Stage-Ⅲ and 7 cases in Stage-Ⅳ. There were 24 cases of atrophy progression, 78 cases of atrophy reversion, 5 cases of intraepithelial neoplasia and 2 cases of gastric cancer. The atrophy progression rate correlated with the rising OLGA stages(χ²=19.14, P<0.001);The rate of atrophy reversion in high-risk group was significantly lower than that in low-risk group(χ²=4.96, P=0.026); The detection rate of intraepithelial neoplasia and gastric cancer in high-risk group was significantly higher than that in low-risk group(χ²=29.63, 11.60, both P<0.05).

Histological OLGA staging system is helpful to realize the risk stratification assessment of gastric precancerous states and precancerous lesions. It has practical significance to formulate individualized endoscopic/histological follow-up plan for OLGA high-risk group.

To investigate the significance of platelet lymphocyte ratio (PLR) before and after neoadjuvant chemotherapy in advanced gastric cancer (AGC).

The medical records of 247 AGC patients who underwent surgery between May 2015 and October 2016 were retrospectively reviewed. The relationship between PLR value and its changes before and after neoadjuvant therapy and clinicopathological features and prognosis was further analyzed.

△PLR was defined according to the different states of PLR before and after neoadjuvant therapy. If negative value was defined as"Reduced Group"(138) and positive value or 0 was defined as "Unreduced group"(109). There were statistical differences between the two groups of△PLR in tumor size, nerve invasion, presence or absence of vascular tumor thrombus, ypT staging, ypN staging, ypTNM staging, and pathological response (all P<0.05), but there was no statistical difference between age, gender, and postoperative adjuvant chemotherapy (all P>0.05). Survival analysis showed that the 5-year disease-free survival rates between the two groups were 39.0% and 54.0%, respectively (P=0.025); the 5-year overall survival rates between the two groups were 41.8% and 58.1%, respectively (P=0.035); the difference were statistically significant. Multivariate analysis showed that ypT3-4 stage, ypN3b stage and △PLR were independent risk factors for 5-year disease-free survival rate (HR=2.731/2.676, 95%CI: 1.026-7.268/1.014-6.985; HR=4.717, 95%CI: 1.922-11.579; HR=2.854, 95%CI: 1.117-4.124; all P<0.05) and 5-year overall survival rate (HR=3.226/2.655, 95%CI: 1.280-9.227/0.945-7.548; HR=4.550, 95%CI: 1.842-11.239; HR=2.897, 95%CI: 1.049-5.251; all P<0. 05).

△PLR can better predict the prognosis of AGC patients receiving neoadjuvant chemotherapy.

To investigate the interactive effect of hypoparathyroidism (HPTH) and type 2 diabetes mellitus (T2DM) on peritonitis in patients on peritoneal dialysis (PD).

In this retrospective cohort study, all PD patients who were firstly catheterized in the peritoneal dialysis center of Guizhou Provincial People′s Hospital from January 1, 2012 to December 31, 2018 were included. The characteristics of demographics, baseline clinical and laboratory data were collected, and patients were followed up until December 31, 2020. Kaplan-Meier survival curve and Cox regression analysis were used to explore the associations between the interaction of HPTH+T2DM and peritonitis.

A total of 270 PD patients were enrolled in this study, aged (39.9±13.2) years, including 143 males and 24 T2DM patients. These serum levels of intact parathyroid hormone (iPTH) [M(Q₁, Q₃)] was 268.1 (121.7, 447.0)pg/ml. After a median follow-up of 29.5 (range from 4.0 to 75.0) months, peritonitis occurred in 69 (25.6%) PD patients for the first time. After controlling for confounding factors, the interaction analysis showed that the risk of peritonitis in T2DM patients with HPTH (n=12) was 3.48 times that of non-T2DM patients without HPTH (n=180) (HR=3.48, 95%CI: 1.04-3.87, P=0.034), which was also greater than the sum of the factors alone (HR=1.35, 95%CI: 0.78-2.31 and HR=0.82, 95%CI: 0.20-3.40). The synergy index between HPTH and T2DM was 1.95, the attributable proportion of interaction was 67.6%, and the relative excess risk of interaction was 2.35. The receiver operating characteristic (ROC) curve indicated that the area under the curve of combined diagnosis of HPTH and T2DM was 0.626 (95%CI: 0.550-0.703, P=0.039).

The positive interaction between HPTH and T2DM is an independent risk factor for peritonitis in PD patients, both of which can significantly increase the risk of peritonitis.

To analyze the clinical features and spinal lesions related to micturitionin of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) patients.

Patients with CP/CPPS were enrolled to this study at the outpatient department of Tongji Hospital between January and June 2019. The data of clinical features was collected and analyzed, including lower urinary tract symptoms(LUTS), bowel syndrome and pain over different parts of body, as well as lower urinary tract dysfunction, spinal lesions and pelvic organ morphological changes demonstrated by MRI. The potential role of spinal lesions in the development of CP/CPPS syndrome was investigated.

A total of 126 CP/CPPS patients were included, with an age［M（Q₁，Q₃）］of 41(31,53) years and a course of disease of 2(1,20) years. Among them, 126 (100.0%) were complicated with LUTS, 72(57.1%) with bowel dysfunction and 88(69.8%) with pain. MRI showed the cervical central disc herniation(126 cases, 100.0%), the ischemic changing in the cervical area of visceral efferant pathway(82 cases, 65.1%), the lumbar central disc herniation(65 cases, 51.6%), and the sacral nerve cysts(97 cases, 77.0%) are commonly seen. In addition, the morphological changes in the visceral organs containing smooth muscle were demonstrated, including thickened bladder wall(91 cases, 72.2%), distended seminal vesicles(70 cases, 55.6%) and distended sigmoid colon/rectum(59 cases, 46.8%).

CP/CPPS patients were characterized by the co-existence of LUTS, bowel dysfunction and somatic pain in one individual. The presence of multi-organ symptoms, combined with the high prevalence of spinal lesions associated with micturition reflex, suggesting the potential role of the spinal lesions in the development of CP/CPPS.

To analyze the factors affecting the live birth outcome of D3 cleavage stage frozen-thawed embryos after overnight culture, and establish a nomogram model to predict the live birth probability.

The clinical data of assisted reproductive patients treated with D3 cleavage stage frozen-thawed embryo transfer in the First Affiliated Hospital of Zhengzhou University from January 2017 to July 2020 were analyzed retrospectively. A total of 5 456 patients were divided into modeling group and validation group according to the ratio of 7∶3. The modeling group [3 831 patients with average age of (33±6) years] was used to evaluate the independent risk factors of the patient′s live birth outcome through multivariate logistic regression analysis and construct the nomogram prediction model. The validation group [1 625 patients with average age of (33±6) years] was used to verify and calibrate the performance of the model.

The results of multivariate logistic regression analysis showed that the risk factors related to live birth outcome of D3 frozen-thawed embryos after overnight culture included: female age (OR=0.901,95%CI:0.889-0.914,P<0.001), body mass index (BMI) (OR=0.979,95%CI:0.957-1.002,P=0.072), endometrial thickness on the transfer day (OR=1.121,95%CI:1.080-1.164,P<0.001), the number of transferred embryos (OR=2.192,95%CI:1.867-2.579,P<0.001) and embryo division resumed after overnight culture (OR=1.405,95%CI:1.213-1.627,P<0.001). The area under the curve (AUC) of the nomogram model in the modeling group was 0.716 and that in the validation group was 0.739.Both sets of calibration curves fited well with the ideal curve, which illustrated that the model had good predictive ability.

The female age, BMI endometrial thickness on the transfer day, the number of transferred embryos and the embryo division resumed after overnight culture are risk factors for the live birth outcome of frozen-thawed embryos after overnight culture. The nomogram established based on the above factors can help predict the probability of live birth after frozen-thawed embryo transfer.

The present paper summarizes the methods and technical key points for urinary reconstruction in mouse kidney transplantation. Both bladder patch and ureter implantation techniques are feasible options for urinary reconstruction in mouse kidney transplantation. The dominant complication in bladder patch technique is ischemic necrosis of patch and distal ureter and is associated with donor mouse strains and surgical skills. The most common complication in ureter implantation technique is urine leakage and is related to recipient mouse gender and technical skills. The key technical points for bladder patch method are estimation of blood supply for bladder patch and properly trimming and suturing bladder walls. The key points for ureter implantation method are properly trimming and fixation of the ureter. Comparing with the bladder patch, the ureter implantation technique is faster, its complications are easier to be repaired by secondary surgery, but the risk of urine retention is higher at late time. The timeliness of surgical intervention is a key factor for successfully repairing the early urinary complications.

This article reports an elderly male patient with chronic kidney disease (CKD) who had type I cardiorenal syndrome (CRS) due to acute myocardial infarction and acute heart failure. He started hemodialysis treatment. Because of the left ventricular ejection fraction (LVEF) of 25%, he was given sacubitril and valsartan sodium (ARNI) orally. After 10 months, the LVEF was 44%, the serum creatinine before dialysis was 330 μ mol/L, and the serum potassium was 5.59 mmol/L.

Postoperative atrial fibrillation (AF) is a common complication after cardiac surgery, which can significantly increase the hospitalization cost and the risk of adverse events. At present, there is a lack of effective prevention strategies for postoperative atrial fibrillation, and it is necessary to further look for controllable risk factors from the aspect of pathogenesis. Epicardial adipose tissue is located between the surface of the myocardium and the visceral pericardium, and is involved in the pathogenesis of many diseases, including preoperative atrial fibrillation. In view of the fact that epicardial adipose tissue is less summarized in postoperative atrial fibrillation, this paper summarizes the related studies of epicardial adipose tissue and postoperative atrial fibrillation, and finds that epicardial adipose tissue participates in the pathogenesis of postoperative atrial fibrillation from anatomical mechanism, secretory function and other ways, which is a powerful direction for future intervention of postoperative atrial fibrillation.

The human intestinal flora forms an extremely complex ecosystem, which not only maintains the stability of the intestinal environment, but also affects the metabolism, immunity, and disease of the host. In recent years, with the gradual deepening of the understanding of intestinal flora, its correlation with blood diseases has also attracted great attention. This article will review the changes of intestinal flora during the occurrence, development and treatment of hematologic diseases, including the potential of intestinal flora as a marker for diagnosing hematologic diseases, the changes of intestinal flora during the treatment of hematologic diseases, and the application prospect of regulating intestinal flora in the treatment of hematologic diseases, in order to provide more new ideas for clinical diagnosis and treatment.

Adjuvant therapy for locally advanced gastric cancer (LAGC) has been developed for more than 20 years, and its efficacy has been proven in multiple trials, but there is still a lack of a global standard strategy. Perioperative chemotherapy (epirubicin, cisplatin + fluorouracil) is mainly used in Europe and the United States; In East Asia, postoperative S-1 or capecitabine + oxaliplatin regimen chemotherapy (SOX or CAPOX) is mainly adopted; In some areas, intensive strategies such as radiotherapy will be added on the basis of adjuvant chemotherapy to improve the efficacy. Experimental studies have shown that perioperative docetaxel and oxaliplatin + fluorouracil (FLOT) regimens are superior to epirubicin and cisplatin + fluorouracil (ECF) regimens; The JACCRO GC-07 and ARTIST 2 trials also showed that intensive adjuvant chemotherapy regimens such as SOX, S-1 plus docetaxel (DS) are superior to standard regimens for patients with advanced gastric cancer. Unlike perioperative chemotherapy in Europe and America, preoperative neoadjuvant chemotherapy is not the standard regimen for LAGC in Korea and even Asia. The team's early phase II study showed that docetaxel and oxaliplatin + S-1 (DOS) neoadjuvant chemotherapy were well tolerated and had a good resection rate in Korean patients with potentially resectable LAGC. To further explore whether combined neoadjuvant DOS surgery and S-1 adjuvant chemotherapy (CSC) compared with postoperative S-1 adjuvant chemotherapy (SC) can improve the prognosis of Korean patients with resectable LAGC, the team designed the PRODIGY study.

Herpes zoster (HZ) is a skin condition with a painful unilateral rash caused by the reactivation of the latent varicella-zoster virus, and its etiology is associated with age-related decline in immune function or suppression of immune function. It is estimated that new HZ cases in China can reach 2.77 million per year. In 2019, the recombinant herpes zoster adjuvant vaccine (RZV) was approved in China for the prevention of HZ in adults aged 50 and older, becoming the first vaccine for the prevention of HZ in my country. This study is based on demographic and epidemiological data of Beijing, using the ZONA model and calculated on a lifetime basis, the impact of RZV vaccination and non-vaccination on public health in people aged 50 years and older.

Gastric cancer, as a heterogeneous disease, has different molecular phenotypes and immune environments, which makes the clinical prognosis and therapeutic effect of patients difficult to predict. In recent years, several studies have demonstrated that immune checkpoint inhibitors (ICIs) are very effective for the treatment of solid tumors, but the overall response rate of immunotherapy in gastric cancer patients is less than 15%. A variety of factors may affect the responsiveness of immunotherapy. Among them, CD8+ cytotoxic T cells will undergo a large number of functional and phenotypic changes in response to tumor antigens to initiate immune responses, and inhibitory receptors such as PD-1 can inhibit this process. Therefore, ICIs can revitalize CD8+ T cell-mediated immunity by blocking these inhibitory receptors. Chemokine ligand 13 (CXCL13) has been studied as a poor survival predictor in a variety of malignancies. The secretory and physiological role of CXCL13 in follicular helper T cells (TFH) has been well described, but the clinical significance of CD8+ tumor infiltrating lymphocytes (TILs) -associated CXCL13 is unclear.

From 1994 to 2018, the incidence of herpes zoster (HZ) increased by 3.1% annually, from 286 per 100,000 person-years to 579 per 100,000 person-years. The protective efficacy of recombinant herpes zoster vaccine (RZV) against herpes zoster has been verified by more than 90% in clinical trials, while in the real world RZV preventive efficacy has not been studied. Since there are clear differences in clinical research and clinical practice, such as the health status of vaccine recipients, HZ diagnostic methods, etc., it is crucial to evaluate the protective efficacy of RZV in the real world. Therefore, the researchers designed a retrospective cohort study through the real-world OLDW (OptumLabs Data Warehouse) database to evaluate the effectiveness of RZV in people aged 50 years and older who are not immunocompromised.