BACKGROUND Intracranial arterial narrowing is a significant factor leading to brief episodes of reduced blood flow to the brain,known as transient ischemic attacks,or fullblown strokes.While atherosclerosis is commonl...BACKGROUND Intracranial arterial narrowing is a significant factor leading to brief episodes of reduced blood flow to the brain,known as transient ischemic attacks,or fullblown strokes.While atherosclerosis is commonly associated with intracranial arterial narrowing,it is frequently of a non-atherosclerotic nature in younger patients.CASE SUMMARY Here,we present the case of a young stroke patient with narrowing of the middle cerebral artery(MCA),characterized as non-atherosclerotic lesions,who experienced an ischemic stroke despite receiving standard drug therapy.The patient underwent digital subtraction angiography(DSA)to assess the entire network of blood vessels in the brain,revealing significant narrowing(approximately 80%)in the M1 segment of the right MCA.Subsequently,the patient underwent Drug-Coated Balloon Angioplasty to treat the stenosis in the right MCA's M1 segment.Follow-up DSA confirmed the resolution of stenosis in this segment.Although the remaining branches showed satisfactory blood flow,the vessel wall exhibited irregularities.A review of DSA conducted six months later showed no evident stenosis in the right MCA,with a smooth vessel wall.CONCLUSION The use of drug-coated balloon angioplasty demonstrated favorable outcomes in repairing and reshaping the blood vessel wall in young patients.Therefore,it may be considered a promising treatment option for similar cases.展开更多
AIM To evaluate the short-term outcomes and quality of life(Qo L) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-latercut overlap method(IJOM) after totally laparos...AIM To evaluate the short-term outcomes and quality of life(Qo L) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-latercut overlap method(IJOM) after totally laparoscopic total gastrectomy(TLTG).METHODS A total of 507 patients who underwent laparoscopic gastrectomy(D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG(group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy(LATG)(group A, n = 456). The short-term outcomes and Qo L were compared between the two groups after 1:2 propensity-score matching(PSM). We used a questionnaire to assess Qo L.RESULTS Before matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups(P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A(P < 0.05). After matching, group T reported better Qo L in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better Qo L("Have you felt pain" and "Have you had difficulty eating solid food")(P < 0.05).CONCLUSION The IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving Qo L after laparoscopic gastrectomy.展开更多
AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anato...AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups(concentrated group vs distributed group) according to the distance between the splenic artery's furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups.RESULTS: There were 205 patients with a concentrated type(64.7%) and 112 patients with a distributed type(35.3%) Sp A. There were 22 patients(6.9%) with a single branch of the splenic lobar vessels, 250(78.9%) with 2 branches, 43(13.6%) with 3 branches, and 2 patients(0.6%) with multiple branches. Eighty sevenpatients(27.4%) had type?Ⅰ?splenic artery trunk, 211(66.6%) had type Ⅱ, 13(4.1%) had type Ⅲ, and 6(1.9%) had type Ⅳ. The mean splenic hilar lymphadenectomy time(23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy(14.78 ± 11.09 vs 17.37 ± 10.62 m L; P = 0.044), and number of vascular clamps used at the splenic hilum(9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups(P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups(P > 0.05).CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type Sp A may be optimal patients for training new surgeons.展开更多
AIM: To evaluate the feasibility and short-term efficacy of laparoscopic spleen-preserving splenic hilar (No. 10) lymphadenectomy to treat advanced upper gastric cancer (AUGC).
AIM:To report the incidence and potential risk factors of small-volume chylous ascites(SVCA)following laparoscopic radical gastrectomy(LAG).METHODS:A total of 1366 consecutive gastric cancer patients who underwent LAG...AIM:To report the incidence and potential risk factors of small-volume chylous ascites(SVCA)following laparoscopic radical gastrectomy(LAG).METHODS:A total of 1366 consecutive gastric cancer patients who underwent LAG from January 2008 to June 2011 were enrolled in this study.We analyzed the patients based on the presence or absence of SVCA.RESULTS:SVCA was detected in 57(4.17%)patients,as determined by the small-volume drainage(range,30-100 m L/24 h)of triglyceride-rich fluid.Both univariate and multivariate analyses revealed that the total number of resected lymph nodes(LNs),No.8 or No.9 LN metastasis and N stage were independent risk factors for SVCA following LAG(P<0.05).Regarding hospital stay,there was a significant difference between the groups with and without SVCA(P<0.001).The 3-year disease-free and overall survival rates of the patients with SVCA were 47.4%and 56.1%,respectively,which were similar to those of the patients without SVCA(P>0.05).CONCLUSION:SVCA following LAG developed significantly more frequently in the patients with≥32harvested LNs,≥3 metastatic LNs,or No.8 or No.9LN metastasis.SVCA,which was successfully treated with conservative management,was associated with a prolonged hospital stay but was not associated with the prognosis.展开更多
BACKGROUND Because of the powerful abilities of self-learning and handling complex biological information,artificial neural network(ANN)models have been widely applied to disease diagnosis,imaging analysis,and prognos...BACKGROUND Because of the powerful abilities of self-learning and handling complex biological information,artificial neural network(ANN)models have been widely applied to disease diagnosis,imaging analysis,and prognosis prediction.However,there has been no trained preoperative ANN(preope-ANN)model to preoperatively predict the prognosis of patients with gastric cancer(GC).AIM To establish a neural network model that can predict long-term survival of GC patients before surgery to evaluate the tumor condition before the operation.METHODS The clinicopathological data of 1608 GC patients treated from January 2011 to April 2015 at the Department of Gastric Surgery,Fujian Medical University Union Hospital were analyzed retrospectively.The patients were randomly divided into a training set(70%)for establishing a preope-ANN model and a testing set(30%).The prognostic evaluation ability of the preope-ANN model was compared with that of the American Joint Commission on Cancer(8th edition)clinical TNM(cTNM)and pathological TNM(pTNM)staging through the receiver operating characteristic curve,Akaike information criterion index,Harrell's C index,and likelihood ratio chi-square.RESULTS We used the variables that were statistically significant factors for the 3-year overall survival as input-layer variables to develop a preope-ANN in the training set.The survival curves within each score of the preope-ANN had good discrimination(P<0.05).Comparing the preope-ANN model,cTNM,and pTNM in both the training and testing sets,the preope-ANN model was superior to cTNM in predictive discrimination(C index),predictive homogeneity(likelihood ratio chi-square),and prediction accuracy(area under the curve).The prediction efficiency of the preope-ANN model is similar to that of pTNM.CONCLUSION The preope-ANN model can accurately predict the long-term survival of GC patients,and its predictive efficiency is not inferior to that of pTNM stage.展开更多
AIM To evaluate the predictive value of the expression of chromosomal maintenance(CRM)1 and cyclindependent kinase(CDK)5 in gastric cancer(GC) patients after gastrectomy.METHODS A total of 240 GC patients who received...AIM To evaluate the predictive value of the expression of chromosomal maintenance(CRM)1 and cyclindependent kinase(CDK)5 in gastric cancer(GC) patients after gastrectomy.METHODS A total of 240 GC patients who received standard gastrectomy were enrolled in the study. The expression level of CRM1 and CDK5 was detected by immunohistochemistry. The correlations between CRM1 and CDK5 expression and clinicopathological factors were explored. Univariate and multivariate survival analyses were used to identify prognostic factors for GC. Receiver operating characteristic analysis was used to compare the accuracy of the prediction of clinical outcome by the parameters. RESULTS The expression of CRM1 was significantly related to size of primary tumor(P = 0.005), Borrmann type(P = 0.006), degree of differentiation(P = 0.004), depth of invasion(P = 0.008), lymph node metastasis(P = 0.013), TNM stage(P = 0.002) and distant metastasis(P = 0.015). The expression of CDK5 was significantly related to sex(P = 0.048) and Lauren's classification(P = 0.011). Multivariate Cox regression analysis identified that CRM1 and CDK5 co-expression status was an independent prognostic factor for overall survival(OS) of patients with GC. Integration of CRM1 and CDK5 expression could provide additional prognostic value for OS compared with CRM1 or CDK5 expression alone(P = 0.001).CONCLUSION CRM1 and CDK5 co-expression was an independent prognostic factors for GC. Combined CRM1 and CDK5 expression could provide a prognostic model for OS of GC.展开更多
BACKGROUND Anastomotic leakage(AL) is a severe complication associated with high morbidity and mortality after radical gastrectomy(RG) for gastric cancer(GC).We hypothesized that a novel abdominal negative pressure la...BACKGROUND Anastomotic leakage(AL) is a severe complication associated with high morbidity and mortality after radical gastrectomy(RG) for gastric cancer(GC).We hypothesized that a novel abdominal negative pressure lavage-drainage system(ANPLDS) can effectively reduce the failure-to-rescue(FTR) and the risk of reoperation, and it is a feasible management for AL.AIM To report our institution's experience with a novel ANPLDS for AL after RG for GC.METHODS The study enrolled 4173 patients who underwent R0 resection for GC at our institution between June 2009 and December 2016. ANPLDS was routinely used for patients with AL after January 2014. Characterization of patients who underwent R0 resection was compared between different study periods. AL rates and postoperative outcome among patients with AL were compared before and after the ANPLDS therapy. We used multivariate analyses to evaluate clinicopathological and perioperative factors for associations with AL and FTR after AL.RESULTS AL occurred in 83(83/4173, 2%) patients, leading to 7 deaths. The mean time of occurrence of AL was 5.6 days. The AL rate was similar before(2009-2013, period1) and after(2014-2016, period 2) the implementation of the ANPLDS therapy(1.7% vs 2.3%, P = 0.121). Age and malnourishment were independently associated with AL. The FTR rate and abdominal bleeding rate after AL occurred were respectively 8.4% and 9.6% for the entire period; however, compared with period 1, this significantly decreased during period 2(16.2% vs 2.2%, P = 0.041;18.9% vs 2.2%, P = 0.020, respectively). Moreover, the reoperation rate was also reduced in period 2, although this result was not statistically significant(13.5% vs2.2%, P = 0.084). Additionally, only ANPLDS therapy was an independent protective factor for FTR after AL(P = 0.04).CONCLUSION Our experience demonstrates that ANPLDS is a feasible management for AL after RG for GC.展开更多
AIM To establish an appropriate N classification system for early gastric cancer(EGC).METHODS Data from 10714 patients who underwent radical gastrectomy between 1988 and2011 were retrieved from the National Cancer Ins...AIM To establish an appropriate N classification system for early gastric cancer(EGC).METHODS Data from 10714 patients who underwent radical gastrectomy between 1988 and2011 were retrieved from the National Cancer Institute's Surveillance,Epidemiology, and End Result database. The overall survival(OS) based on the eighth edition and new tumor lymph node metastasis(TNM) staging systems were compared, and the analysis was repeated in an external validation set from the Fujian Medical University Union Hospital database.RESULTS There were no significant differences in OS between N1 and N2 cancers or between N3a and N3b cancers in cases of EGC. The X-tile program identified that the new staging system for EGC consisted of T1N0, T1N1' [1-6 metastatic lymph nodes(LNs)], and T1N2'( ≥ 7 metastatic LNs). Compared with the eighth edition of the TNM staging system, the OS of patients in T1N1' stage was similar to that of patients with stage IIA disease, whereas the OS of patients in T1N2' stage was similar to that of patients with stage IIB disease. The new TNM staging system exhibited a slightly lower Akaike Information Criterion value and higher χ~2 and c-statistic compared with the eighth edition of the TNM classification system.Similar results were found in the external validation dataset from the external validation set.CONCLUSION We have developed an optional new TNM staging system with a better predictive ability that can be used to accurately predict the 5-year OS of patients with EGC.展开更多
BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures.AIM To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic...BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures.AIM To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy(SPSHL)for advanced gastric cancer(GC)by Huang’s three-step maneuver.METHODS A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017,including 35 patients who underwent robotic SPSHL(RSPSHL)and 608 who underwent laparoscopic SPSHL(LSPSHL).One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic SPSHL.RESULTS In all,175 patients were matched,including 35 patients who underwent RSPSHL and 140 who underwent LSPSHL.After matching,there were no significant differences detected in the baseline characteristics between the two groups.Significant differences in total operative time,estimated blood loss(EBL),splenic hilar blood loss(SHBL),splenic hilar dissection time(SHDT),and splenic trunk dissection time were evident between these groups(P<0.05).Furthermore,no significant differences were observed between the two groups in the overall noncompliance rate of lymph node(LN)dissection(62.9%vs 60%,P=0.757),number of retrieved No.10 LNs(3.1±1.4 vs 3.3±2.5,P=0.650),total number of examined LNs(37.8±13.1 vs 40.6±13.6,P=0.274),and postoperative complications(14.3%vs 17.9%,P=0.616).A stratified analysis that divided the patients receiving RSPSHL into an early group(EG)and a late group(LG)revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG(P<0.05).Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT(P<0.05).CONCLUSION RSPSHL is safe and feasible,especially after overcoming the early learning curve,as this procedure results in a radical curative effect equivalent to that of LSPSHL.展开更多
For advanced proximal gastric cancer(GC),splenic hilar(No.10) lymph nodes(LN) are crucial links in lymphatic drainage.According to the 14^(th) edition of the Japanese GC treatment guidelines,a D2 lymphadenectomy is th...For advanced proximal gastric cancer(GC),splenic hilar(No.10) lymph nodes(LN) are crucial links in lymphatic drainage.According to the 14^(th) edition of the Japanese GC treatment guidelines,a D2 lymphadenectomy is the standard surgery for advanced GC,and No.10 LN should be dissected for advanced proximal GC.In recent years,the preservation of organ function and the use of minimally invasive technology are being accepted by an increasing number of clinicians.Laparoscopic spleenpreserving splenic hilar LN dissection has become more accepted and is gradually being used in operations.However,because of the complexity of splenic hilar anatomy,mastering the strategies for laparoscopic spleen-preserving splenic hilar LN dissection is critical for successfully completing the operation.展开更多
AIM To investigate the effects of different levels of expression of CDK5RAP3 and DDRGK1 on long-term survival of patients undergoing radical gastrectomy.METHODS The expression of CDK5RAP3 and DDRGK1 was detected by im...AIM To investigate the effects of different levels of expression of CDK5RAP3 and DDRGK1 on long-term survival of patients undergoing radical gastrectomy.METHODS The expression of CDK5RAP3 and DDRGK1 was detected by immunohistochemistry in 135 patients who received standard gastrectomy were enrolled in the study. Western Blot was used to detect the expression of CDK5RAP3 and DDRGK1 in gastric cancer and its adjacent tissues and cell lines. The correlations between the expression of CDK5RAP3 and DDRGK1 and clinicopathological factors were analyzed, and the value of each parameter to the prognosis of the patients was compared. Receiver operating characteristic analysis was used to compare the accuracy of the prediction of clinical outcome by the parameters.RESULTS CDK5RAP3 and DDRGK1 expression was downregulated in the gastric cancer compared to its respective adjacent non-tumor tissues. The expression of CDK5RAP3 was closely related to the age of the patients(P = 0.035) and the T stage of the tumor(P = 0.017). The expression of DDRGK1 was correlated with the sex of the patients(P = 0.080), the degree of tumor differentiation(P = 0.036), the histological type(P = 0.036) and the N stage of the tumor(P = 0.014). Low expression CDK5RAP3 or DDRGK1 is a poor prognostic factor for gastric cancer patients. Prognostic analysis showed that the co-expression of CDK5RAP3 and DDRGK1 was an independent prognostic factor correlating with the overall survival of gastric cancer patients. Combined expression analysis of CDK5RAP3 and DDRGK1 may provide a more accurate prognostic value for overall survival.展开更多
BACKGROUND Increasing numbers of laboratory blood parameters(BPM)have been reported to greatly affect the long-term outcomes of gastric cancer(GC)patients.However,the existing prognostic models do not comprehensively ...BACKGROUND Increasing numbers of laboratory blood parameters(BPM)have been reported to greatly affect the long-term outcomes of gastric cancer(GC)patients.However,the existing prognostic models do not comprehensively analyze these predictors.AIM To construct a new prognostic tool,based on all the prognostic BPM,to achieve more accurate prognosis prediction for GC.METHODS We retrospectively assessed 850 consecutive patients who underwent curative resection for stage II-III GC from January 2010 to April 2013.The patients were classified into developing(n=567)and validation(n=283)cohorts using computer-generated random numbers.A scoring system,namely BPM score,was then constructed using least absolute shrinkage and selection operator(LASSO)Cox regression model in the developing cohort,and validated in the validation cohort.A nomogram consisting of BPM score and tumor-lymph node-metastasis(TNM)stage was further created.The discrimination and calibration of the nomogram were evaluated via Harrell’s C-statistic and the Hosmer-Lemeshow test.RESULTS Using the LASSO model,we established the BPM score based on five BPM:Albumin,lymphocyte-to-monocyte ratio,neutrophil-to-lymphocyte ratio,carcinoembryonic antigen,and carbohydrate antigen 19-9.The BPM scores were divided into high-and low-BPM groups based on a cut-off value of-0.93.High-BPM patients were significantly older and had more advanced,larger tumors.In the developing cohort,significant differences were found in 5-year overall survival(OS)and 5-year disease-specific survival between the high-BPM and low-BPM patients.Similar results were found in the validation group.Multivariable analysis showed that the BPM score was an independent predictor of OS.High-BPM patients had a poorer 5-year OS for each subgroup.Furthermore,a nomogram that combined the BPM score and TNM stage had significantly better prognostic value compared with TNM stage alone.CONCLUSION The BPM score provides more accurate prognosis prediction in stage Ⅱ-Ⅲ GC patients and is an effective complement to the TNM staging system.展开更多
AIM To assess the predictive value of the tumor-associated neutrophil-to-lymphocyte ratio in terms of the clinical outcomes of patients with gastric neuroendocrine neoplasms after radical surgery.METHODS Data were ret...AIM To assess the predictive value of the tumor-associated neutrophil-to-lymphocyte ratio in terms of the clinical outcomes of patients with gastric neuroendocrine neoplasms after radical surgery.METHODS Data were retrospectively collected from 142 patients who were diagnosed with gastric neuroendocrine neoplasms and who underwent radical gastrectomy at our department from March 2006 to March 2015. These data were retrospectively analyzed, and a receiver operating characteristic curve analysis was used to identify the optimal value of the tumorassociated neutrophil-to-lymphocyte ratio. Univariate and multivariate survival analyses were used to identify prognostic factors. A nomogram was then applied to predict clinical outcomes after surgery.RESULTS The tumor-associated neutrophil-to-lymphocyte ratio was significantly associated with tumor recurrence, especially with liver metastasis and lymph node metastasis(P < 0.05 for both), but not with clinical characteristics(P > 0.05 for all). A multivariate Cox regression analysis identified the tumor-associatedneutrophil-to-lymphocyte ratio as an independent prognostic factor for recurrence-free survival and overall survival(P < 0.05 for both). The concordance index of the nomograms, which included the tumorassociated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio, was 0.788(0.759) for recurrence-free survival(overall survival) and was higher than the concordance index of the traditional TNM staging system [0.672(0.663)].CONCLUSION The tumor-associated neutrophil-to-lymphocyte ratio is an independent prognostic factor in patients with gastric neuroendocrine neoplasms. Nomograms that include the tumor-associated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio have a superior ability to predict clinical outcomes of postoperative patients.展开更多
Transmission efficiency(TE) and focal ratio degradation(FRD) are two important parameters for evaluating the quality of an optical fiber system used for astronomy. Compared to TE, the focal ratio is more easily influe...Transmission efficiency(TE) and focal ratio degradation(FRD) are two important parameters for evaluating the quality of an optical fiber system used for astronomy. Compared to TE, the focal ratio is more easily influenced by external factors, such as bending or stress. Optical cables are widely implemented for multi-object telescopes and integral field units(IFUs). The design and fabrication process of traditional optical cables seldom considers the requirements of astronomical applications. In this paper, we describe a fiber bundle structure as the basic unit for miniaturized high-density FASOT-IFU optical cables,instead of the micro-tube structure in stranded cables. Seven fibers with hexagonal arrangement were accurately positioned by ultraviolet(UV)-curing acrylate to form the bundle. The coating diameter of a fiber is0.125 mm, and the outer diameter of the bundle is 0.58 mm. Compared with the 0.8 mm micro-tube structure of a traditional stranded cable, the outer diameter of the fiber bundle was reduced by 27.5%. Fiber paste was filled into the bundle to reduce stress between the fibers. We tested the output focal ratio(OFR) in95% of the encircled energy(EE95) of the fibers in the bundle under different conditions. With the incident focal ratio F/8, the maximum difference of OFR is 0.6. In particular, when the incident focal ratio is F/5,the maximum difference of OFR is only 0.1. The jacket formed by the UV-curing acrylate can withstand a certain stress of less than 1.38 N mm-1. The fiber bundle can maintain uniform emitting characteristics with a bending radius of 7.5 cm and with tension less than 6 N. The test results show that the structure of the fiber bundle can be used as a basic unit for miniaturized high-density astronomical optical cables.展开更多
BACKGROUND The incidence of proximal gastric cancer(GC)is increasing,and methods for the prediction of the long-term survival of proximal GC patients have not been well established.AIM To develop nomograms for the pre...BACKGROUND The incidence of proximal gastric cancer(GC)is increasing,and methods for the prediction of the long-term survival of proximal GC patients have not been well established.AIM To develop nomograms for the prediction of long-term survival among proximal GC patients.METHODS Between January 2007 and June 2013,we prospectively collected and retrospectively analyzed the medical records of 746 patients with proximal GC,who were divided into a training set(n=560,75%)and a validation set(n=186,25%).A Cox regression analysis was used to identify the preoperative and postoperative risk factors for overall survival(OS).RESULTS Among the 746 patients examined,the 3-and 5-year OS rates were 66.1%and 58.4%,respectively.In the training set,preoperative T stage(cT),N stage(cN),CA19-9,tumor size,ASA core,and 3-to 6-mo weight loss were incorporated into the preoperative nomogram to predict the OS.In addition to these variables,lymphatic vascular infiltration(LVI),postoperative tumor size,T stage,N stage,blood transfusions,and complications were incorporated into the postoperative nomogram.All calibration curves used to determine the OS probability fit well.In the training set,the preoperative nomogram achieved a C-index of 0.751[95%confidence interval(CI):0.732-0.770]in predicting OS and accurately stratified the patients into four prognostic subgroups(5-year OS rates:86.8%,73.0%,43.72%,and 20.9%,P<0.001).The postoperative nomogram had a C-index of 0.758 in predicting OS and accurately stratified the patients into four prognostic subgroups(5-year OS rates:82.6%,74.3%,45.9%,and 18.9%,P<0.001).CONCLUSION The nomograms accurately predicted the pre-and postoperative long-term survival of proximal GC patients.展开更多
Background:Little is known about the correlation between the clinicopathological features,postoperative treatment,and prognosis of multiple gastric cancers(MGCs).In this study,we aimed to investigate the correlation b...Background:Little is known about the correlation between the clinicopathological features,postoperative treatment,and prognosis of multiple gastric cancers(MGCs).In this study,we aimed to investigate the correlation between these features and the impact of postoperative adjuvant chemotherapy on the long-term survival of patients with MGC.Methods:The clinical and pathological data of patients diagnosed with gastric adenocarcinoma who had radical gastrectomy from January 2007 to December 2016 were analyzed.Using propensity score matching,the prognostic differences,and the impact of postoperative adjuvant chemotherapy between those with MGC and solitary gastric cancers(SGC)were compared.Results:Among the 4107 patients investigated,the incidence of MGC was 3.2%(133/4107).Before matching,patients with MGC and SGC had disparities in the type of gastrectomy,pathological tumor stage(pT),pathological node stage(pN),and pathological tumor-node-metastasis stage(pTNM).After a 1:4 ratio matching,the clinical data of 133 cases of MGC and 532 cases of SGC were found to be comparable.The 5-year overall survival(OS)rate was 56.6%in the entire matched cohort,48.1%in the MGC group,and 58.7%in the SGC group(P=0.013).Multivariate analysis revealed that MGC,age,pT stage,pN stage,and adjuvant chemotherapy were independent predictors of OS(all P<0.05).Stratified analyses demonstrated that for the cohort of advanced gastric cancer(AGC)patients who did not had adjuvant chemotherapy,the 5-year OS rate of advanced cases of MGC was inferior than that of SGC patients(34.0%vs.46.1%,respectively;P=0.025)but there were no significant difference in the 5-year OS rate between advanced MGC and SGC patients who had adjuvant chemotherapy(48.0%vs.53.3%,respectively;P=0.292).Further,we found that the 5-year OS rate of advanced MGC who had adjuvant chemotherapy was significantly higher than those who did not had adjuvant chemotherapy(48.0%vs.34.0%,P=0.026).Conclusions:Patients with advanced MGC was identified as having a poorer survival as to SGC patients,but the implementation of postoperative adjuvant chemotherapy showed that it had the potential to significantly improve the long-term prognoses of MGC patients.展开更多
文摘BACKGROUND Intracranial arterial narrowing is a significant factor leading to brief episodes of reduced blood flow to the brain,known as transient ischemic attacks,or fullblown strokes.While atherosclerosis is commonly associated with intracranial arterial narrowing,it is frequently of a non-atherosclerotic nature in younger patients.CASE SUMMARY Here,we present the case of a young stroke patient with narrowing of the middle cerebral artery(MCA),characterized as non-atherosclerotic lesions,who experienced an ischemic stroke despite receiving standard drug therapy.The patient underwent digital subtraction angiography(DSA)to assess the entire network of blood vessels in the brain,revealing significant narrowing(approximately 80%)in the M1 segment of the right MCA.Subsequently,the patient underwent Drug-Coated Balloon Angioplasty to treat the stenosis in the right MCA's M1 segment.Follow-up DSA confirmed the resolution of stenosis in this segment.Although the remaining branches showed satisfactory blood flow,the vessel wall exhibited irregularities.A review of DSA conducted six months later showed no evident stenosis in the right MCA,with a smooth vessel wall.CONCLUSION The use of drug-coated balloon angioplasty demonstrated favorable outcomes in repairing and reshaping the blood vessel wall in young patients.Therefore,it may be considered a promising treatment option for similar cases.
基金Supported by National Key Clinical Specialty Discipline Construction program of China,No.[2012]649Key Project of Science and Technology Plan of Fujian Province,No.2014Y0025
文摘AIM To evaluate the short-term outcomes and quality of life(Qo L) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-latercut overlap method(IJOM) after totally laparoscopic total gastrectomy(TLTG).METHODS A total of 507 patients who underwent laparoscopic gastrectomy(D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG(group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy(LATG)(group A, n = 456). The short-term outcomes and Qo L were compared between the two groups after 1:2 propensity-score matching(PSM). We used a questionnaire to assess Qo L.RESULTS Before matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups(P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A(P < 0.05). After matching, group T reported better Qo L in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better Qo L("Have you felt pain" and "Have you had difficulty eating solid food")(P < 0.05).CONCLUSION The IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving Qo L after laparoscopic gastrectomy.
基金Supported by National Key Clinical Specialty Discipline Construction Program of China,No.[2012]649Key Project of Science and Technology Plan of Fujian Province,China,No.2014Y0025
文摘AIM: To investigate the splenic hilar vascular anatomy and the influence of splenic artery(Sp A) type in laparoscopic total gastrectomy with spleen-preserving splenic lymphadenectomy(LTGSPL).METHODS:The clinical anatomy data of 317 patients with upper- or middle-third gastric cancer who underwent LTGSPL in our hospital from January 2011 to December 2013 were collected. The patients were divided into two groups(concentrated group vs distributed group) according to the distance between the splenic artery's furcation and the splenic hilar region. Then, the anatomical layout, clinicopathologic characteristics, intraoperative variables, and postoperative variables were compared between the two groups.RESULTS: There were 205 patients with a concentrated type(64.7%) and 112 patients with a distributed type(35.3%) Sp A. There were 22 patients(6.9%) with a single branch of the splenic lobar vessels, 250(78.9%) with 2 branches, 43(13.6%) with 3 branches, and 2 patients(0.6%) with multiple branches. Eighty sevenpatients(27.4%) had type?Ⅰ?splenic artery trunk, 211(66.6%) had type Ⅱ, 13(4.1%) had type Ⅲ, and 6(1.9%) had type Ⅳ. The mean splenic hilar lymphadenectomy time(23.15 ± 8.02 vs 26.21 ± 8.84 min; P = 0.002), mean blood loss resulting from splenic hilar lymphadenectomy(14.78 ± 11.09 vs 17.37 ± 10.62 m L; P = 0.044), and number of vascular clamps used at the splenic hilum(9.64 ± 2.88 vs 10.40 ± 3.57; P = 0.040) were significantly lower in the concentrated group than in the distributed group. However, the mean total surgical time, mean total blood loss, and the mean number of harvested splenic hilar lymph nodes were similar in both groups(P > 0.05 for each comparison). There were also no significant differences in clinicopathological and postoperative characteristics between the groups(P > 0.05).CONCLUSION: It is of value for surgeons to know the splenic hilar vascular anatomy when performing LTGSPL. Patients with concentrated type Sp A may be optimal patients for training new surgeons.
基金Supported by the National Key Clinical Specialty DisciplineConstruction Program of China,No.[2012]649
文摘AIM: To evaluate the feasibility and short-term efficacy of laparoscopic spleen-preserving splenic hilar (No. 10) lymphadenectomy to treat advanced upper gastric cancer (AUGC).
基金Supported by Grants from National Key Clinical Specialty Discipline Construction Program of China,No.[2012]649
文摘AIM:To report the incidence and potential risk factors of small-volume chylous ascites(SVCA)following laparoscopic radical gastrectomy(LAG).METHODS:A total of 1366 consecutive gastric cancer patients who underwent LAG from January 2008 to June 2011 were enrolled in this study.We analyzed the patients based on the presence or absence of SVCA.RESULTS:SVCA was detected in 57(4.17%)patients,as determined by the small-volume drainage(range,30-100 m L/24 h)of triglyceride-rich fluid.Both univariate and multivariate analyses revealed that the total number of resected lymph nodes(LNs),No.8 or No.9 LN metastasis and N stage were independent risk factors for SVCA following LAG(P<0.05).Regarding hospital stay,there was a significant difference between the groups with and without SVCA(P<0.001).The 3-year disease-free and overall survival rates of the patients with SVCA were 47.4%and 56.1%,respectively,which were similar to those of the patients without SVCA(P>0.05).CONCLUSION:SVCA following LAG developed significantly more frequently in the patients with≥32harvested LNs,≥3 metastatic LNs,or No.8 or No.9LN metastasis.SVCA,which was successfully treated with conservative management,was associated with a prolonged hospital stay but was not associated with the prognosis.
基金the Scientific and Technological Innovation JointCapital Projects of Fujian Province,No.2016Y9031the Construction Project of Fujian Province Minimally Invasive Medical Center,No.[2017]171+4 种基金the General Project of Miaopu Scientific Research Fund of Fujian Medical University,No.2015MP021the Youth Project of Fujian Provincial Health and Family Planning Commission,No.2016-1-41the Fujian Province Medical Innovation ProjectChinese Physicians Association Young Physician Respiratory Research Fund,No.2015-CXB-16the Fujian Science and Technology Innovation Joint Fund Project,No.2017Y9004
文摘BACKGROUND Because of the powerful abilities of self-learning and handling complex biological information,artificial neural network(ANN)models have been widely applied to disease diagnosis,imaging analysis,and prognosis prediction.However,there has been no trained preoperative ANN(preope-ANN)model to preoperatively predict the prognosis of patients with gastric cancer(GC).AIM To establish a neural network model that can predict long-term survival of GC patients before surgery to evaluate the tumor condition before the operation.METHODS The clinicopathological data of 1608 GC patients treated from January 2011 to April 2015 at the Department of Gastric Surgery,Fujian Medical University Union Hospital were analyzed retrospectively.The patients were randomly divided into a training set(70%)for establishing a preope-ANN model and a testing set(30%).The prognostic evaluation ability of the preope-ANN model was compared with that of the American Joint Commission on Cancer(8th edition)clinical TNM(cTNM)and pathological TNM(pTNM)staging through the receiver operating characteristic curve,Akaike information criterion index,Harrell's C index,and likelihood ratio chi-square.RESULTS We used the variables that were statistically significant factors for the 3-year overall survival as input-layer variables to develop a preope-ANN in the training set.The survival curves within each score of the preope-ANN had good discrimination(P<0.05).Comparing the preope-ANN model,cTNM,and pTNM in both the training and testing sets,the preope-ANN model was superior to cTNM in predictive discrimination(C index),predictive homogeneity(likelihood ratio chi-square),and prediction accuracy(area under the curve).The prediction efficiency of the preope-ANN model is similar to that of pTNM.CONCLUSION The preope-ANN model can accurately predict the long-term survival of GC patients,and its predictive efficiency is not inferior to that of pTNM stage.
基金Supported by National Natural Science Foundation of China,No.81441123(to Huang CM),No.31640053(to Lin Y)National Key Clinical Specialty Discipline Construction Program of China,No.[2012]649+1 种基金Key Scientific and Technological Project of Fujian Province,China,No.2014Y0025(to Huang CM)Natural Science Foundation of Fujian Province,China,No.2014J01322(to Xie JW),No.2016Y0029(to Lin Y)
文摘AIM To evaluate the predictive value of the expression of chromosomal maintenance(CRM)1 and cyclindependent kinase(CDK)5 in gastric cancer(GC) patients after gastrectomy.METHODS A total of 240 GC patients who received standard gastrectomy were enrolled in the study. The expression level of CRM1 and CDK5 was detected by immunohistochemistry. The correlations between CRM1 and CDK5 expression and clinicopathological factors were explored. Univariate and multivariate survival analyses were used to identify prognostic factors for GC. Receiver operating characteristic analysis was used to compare the accuracy of the prediction of clinical outcome by the parameters. RESULTS The expression of CRM1 was significantly related to size of primary tumor(P = 0.005), Borrmann type(P = 0.006), degree of differentiation(P = 0.004), depth of invasion(P = 0.008), lymph node metastasis(P = 0.013), TNM stage(P = 0.002) and distant metastasis(P = 0.015). The expression of CDK5 was significantly related to sex(P = 0.048) and Lauren's classification(P = 0.011). Multivariate Cox regression analysis identified that CRM1 and CDK5 co-expression status was an independent prognostic factor for overall survival(OS) of patients with GC. Integration of CRM1 and CDK5 expression could provide additional prognostic value for OS compared with CRM1 or CDK5 expression alone(P = 0.001).CONCLUSION CRM1 and CDK5 co-expression was an independent prognostic factors for GC. Combined CRM1 and CDK5 expression could provide a prognostic model for OS of GC.
基金Supported by Scientific and Technological Innovation Joint Capital Projects of Fujian Province,No.2016Y9031Construction Project of Fujian Province Minimally Invasive Medical Center,No.[2017]171+2 种基金The Second Batch of Special Support Funds for Fujian Province Innovation and Entrepreneurship Talents,No.2016B013Youth Scientific Research Subject of Fujian Provincial Health and Family Planning Commission,No.2015-1-37QIHANG Funds of Fujian Medical University,No.2016QH025
文摘BACKGROUND Anastomotic leakage(AL) is a severe complication associated with high morbidity and mortality after radical gastrectomy(RG) for gastric cancer(GC).We hypothesized that a novel abdominal negative pressure lavage-drainage system(ANPLDS) can effectively reduce the failure-to-rescue(FTR) and the risk of reoperation, and it is a feasible management for AL.AIM To report our institution's experience with a novel ANPLDS for AL after RG for GC.METHODS The study enrolled 4173 patients who underwent R0 resection for GC at our institution between June 2009 and December 2016. ANPLDS was routinely used for patients with AL after January 2014. Characterization of patients who underwent R0 resection was compared between different study periods. AL rates and postoperative outcome among patients with AL were compared before and after the ANPLDS therapy. We used multivariate analyses to evaluate clinicopathological and perioperative factors for associations with AL and FTR after AL.RESULTS AL occurred in 83(83/4173, 2%) patients, leading to 7 deaths. The mean time of occurrence of AL was 5.6 days. The AL rate was similar before(2009-2013, period1) and after(2014-2016, period 2) the implementation of the ANPLDS therapy(1.7% vs 2.3%, P = 0.121). Age and malnourishment were independently associated with AL. The FTR rate and abdominal bleeding rate after AL occurred were respectively 8.4% and 9.6% for the entire period; however, compared with period 1, this significantly decreased during period 2(16.2% vs 2.2%, P = 0.041;18.9% vs 2.2%, P = 0.020, respectively). Moreover, the reoperation rate was also reduced in period 2, although this result was not statistically significant(13.5% vs2.2%, P = 0.084). Additionally, only ANPLDS therapy was an independent protective factor for FTR after AL(P = 0.04).CONCLUSION Our experience demonstrates that ANPLDS is a feasible management for AL after RG for GC.
基金Supported by Scientific and Technological Innovation Joint Capital Projects of Fujian Province,China,No.2016Y9031Construction Project of Fujian Province Minimally Invasive Medical Center,No.[2017]171
文摘AIM To establish an appropriate N classification system for early gastric cancer(EGC).METHODS Data from 10714 patients who underwent radical gastrectomy between 1988 and2011 were retrieved from the National Cancer Institute's Surveillance,Epidemiology, and End Result database. The overall survival(OS) based on the eighth edition and new tumor lymph node metastasis(TNM) staging systems were compared, and the analysis was repeated in an external validation set from the Fujian Medical University Union Hospital database.RESULTS There were no significant differences in OS between N1 and N2 cancers or between N3a and N3b cancers in cases of EGC. The X-tile program identified that the new staging system for EGC consisted of T1N0, T1N1' [1-6 metastatic lymph nodes(LNs)], and T1N2'( ≥ 7 metastatic LNs). Compared with the eighth edition of the TNM staging system, the OS of patients in T1N1' stage was similar to that of patients with stage IIA disease, whereas the OS of patients in T1N2' stage was similar to that of patients with stage IIB disease. The new TNM staging system exhibited a slightly lower Akaike Information Criterion value and higher χ~2 and c-statistic compared with the eighth edition of the TNM classification system.Similar results were found in the external validation dataset from the external validation set.CONCLUSION We have developed an optional new TNM staging system with a better predictive ability that can be used to accurately predict the 5-year OS of patients with EGC.
基金Supported by the Scientific and Technological Innovation Joint Capital Projects of Fujian Province,China,No.2016Y9031the Construction Project of Fujian Province Minimally Invasive Medical Center,No.[2017]171+2 种基金the Second-batch Special Support Funds for Fujian Province Innovation and Entrepreneurship Talents,No.2016B013Science and Technology Innovation Joint Fund Project of Fujian Province,No.2017Y9004the Special Fund for Clinical Research of the Wu Jieping Medical Foundation,No.320.6750.17511
文摘BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures.AIM To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy(SPSHL)for advanced gastric cancer(GC)by Huang’s three-step maneuver.METHODS A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017,including 35 patients who underwent robotic SPSHL(RSPSHL)and 608 who underwent laparoscopic SPSHL(LSPSHL).One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic SPSHL.RESULTS In all,175 patients were matched,including 35 patients who underwent RSPSHL and 140 who underwent LSPSHL.After matching,there were no significant differences detected in the baseline characteristics between the two groups.Significant differences in total operative time,estimated blood loss(EBL),splenic hilar blood loss(SHBL),splenic hilar dissection time(SHDT),and splenic trunk dissection time were evident between these groups(P<0.05).Furthermore,no significant differences were observed between the two groups in the overall noncompliance rate of lymph node(LN)dissection(62.9%vs 60%,P=0.757),number of retrieved No.10 LNs(3.1±1.4 vs 3.3±2.5,P=0.650),total number of examined LNs(37.8±13.1 vs 40.6±13.6,P=0.274),and postoperative complications(14.3%vs 17.9%,P=0.616).A stratified analysis that divided the patients receiving RSPSHL into an early group(EG)and a late group(LG)revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG(P<0.05).Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT(P<0.05).CONCLUSION RSPSHL is safe and feasible,especially after overcoming the early learning curve,as this procedure results in a radical curative effect equivalent to that of LSPSHL.
基金Supported by National Key Clinical Specialty Discipline Construction program of China,No.2012-649the Key Project of Science and Technology Plan of Fujian Province,China,No.2014Y0025
文摘For advanced proximal gastric cancer(GC),splenic hilar(No.10) lymph nodes(LN) are crucial links in lymphatic drainage.According to the 14^(th) edition of the Japanese GC treatment guidelines,a D2 lymphadenectomy is the standard surgery for advanced GC,and No.10 LN should be dissected for advanced proximal GC.In recent years,the preservation of organ function and the use of minimally invasive technology are being accepted by an increasing number of clinicians.Laparoscopic spleenpreserving splenic hilar LN dissection has become more accepted and is gradually being used in operations.However,because of the complexity of splenic hilar anatomy,mastering the strategies for laparoscopic spleen-preserving splenic hilar LN dissection is critical for successfully completing the operation.
基金Supported by the Science Foundation of the Fujian Province,China,No.2018J01307Startup Fund for Scientific Research,Fujian Medical University,No.2016QH024+2 种基金Scientific and Technological innovation Joint Capital Projects of Fujian Province,No.2016Y9031Minimally invasive Medical Center of Fujian Province,No.2011708#the Young and Middleaged Talent Training Project of the Fujian Provincial Health and Family Planning Commission,No.2014-ZQNJC-13
文摘AIM To investigate the effects of different levels of expression of CDK5RAP3 and DDRGK1 on long-term survival of patients undergoing radical gastrectomy.METHODS The expression of CDK5RAP3 and DDRGK1 was detected by immunohistochemistry in 135 patients who received standard gastrectomy were enrolled in the study. Western Blot was used to detect the expression of CDK5RAP3 and DDRGK1 in gastric cancer and its adjacent tissues and cell lines. The correlations between the expression of CDK5RAP3 and DDRGK1 and clinicopathological factors were analyzed, and the value of each parameter to the prognosis of the patients was compared. Receiver operating characteristic analysis was used to compare the accuracy of the prediction of clinical outcome by the parameters.RESULTS CDK5RAP3 and DDRGK1 expression was downregulated in the gastric cancer compared to its respective adjacent non-tumor tissues. The expression of CDK5RAP3 was closely related to the age of the patients(P = 0.035) and the T stage of the tumor(P = 0.017). The expression of DDRGK1 was correlated with the sex of the patients(P = 0.080), the degree of tumor differentiation(P = 0.036), the histological type(P = 0.036) and the N stage of the tumor(P = 0.014). Low expression CDK5RAP3 or DDRGK1 is a poor prognostic factor for gastric cancer patients. Prognostic analysis showed that the co-expression of CDK5RAP3 and DDRGK1 was an independent prognostic factor correlating with the overall survival of gastric cancer patients. Combined expression analysis of CDK5RAP3 and DDRGK1 may provide a more accurate prognostic value for overall survival.
基金Supported by the Scientific and Technological Innovation Joint Capital Projects of Fujian Province,No.2016Y9031the Minimally Invasive Medical Center of Fujian Province,No.[2017]171+1 种基金the Science Foundation of Fujian Province,No.2018J01307the Startup Fund for Scientific Research,Fujian Medical University,No.2016QH024
文摘BACKGROUND Increasing numbers of laboratory blood parameters(BPM)have been reported to greatly affect the long-term outcomes of gastric cancer(GC)patients.However,the existing prognostic models do not comprehensively analyze these predictors.AIM To construct a new prognostic tool,based on all the prognostic BPM,to achieve more accurate prognosis prediction for GC.METHODS We retrospectively assessed 850 consecutive patients who underwent curative resection for stage II-III GC from January 2010 to April 2013.The patients were classified into developing(n=567)and validation(n=283)cohorts using computer-generated random numbers.A scoring system,namely BPM score,was then constructed using least absolute shrinkage and selection operator(LASSO)Cox regression model in the developing cohort,and validated in the validation cohort.A nomogram consisting of BPM score and tumor-lymph node-metastasis(TNM)stage was further created.The discrimination and calibration of the nomogram were evaluated via Harrell’s C-statistic and the Hosmer-Lemeshow test.RESULTS Using the LASSO model,we established the BPM score based on five BPM:Albumin,lymphocyte-to-monocyte ratio,neutrophil-to-lymphocyte ratio,carcinoembryonic antigen,and carbohydrate antigen 19-9.The BPM scores were divided into high-and low-BPM groups based on a cut-off value of-0.93.High-BPM patients were significantly older and had more advanced,larger tumors.In the developing cohort,significant differences were found in 5-year overall survival(OS)and 5-year disease-specific survival between the high-BPM and low-BPM patients.Similar results were found in the validation group.Multivariable analysis showed that the BPM score was an independent predictor of OS.High-BPM patients had a poorer 5-year OS for each subgroup.Furthermore,a nomogram that combined the BPM score and TNM stage had significantly better prognostic value compared with TNM stage alone.CONCLUSION The BPM score provides more accurate prognosis prediction in stage Ⅱ-Ⅲ GC patients and is an effective complement to the TNM staging system.
基金Supported by National Key Clinical Specialty Discipline Construction Program of China,No.[2012]649
文摘AIM To assess the predictive value of the tumor-associated neutrophil-to-lymphocyte ratio in terms of the clinical outcomes of patients with gastric neuroendocrine neoplasms after radical surgery.METHODS Data were retrospectively collected from 142 patients who were diagnosed with gastric neuroendocrine neoplasms and who underwent radical gastrectomy at our department from March 2006 to March 2015. These data were retrospectively analyzed, and a receiver operating characteristic curve analysis was used to identify the optimal value of the tumorassociated neutrophil-to-lymphocyte ratio. Univariate and multivariate survival analyses were used to identify prognostic factors. A nomogram was then applied to predict clinical outcomes after surgery.RESULTS The tumor-associated neutrophil-to-lymphocyte ratio was significantly associated with tumor recurrence, especially with liver metastasis and lymph node metastasis(P < 0.05 for both), but not with clinical characteristics(P > 0.05 for all). A multivariate Cox regression analysis identified the tumor-associatedneutrophil-to-lymphocyte ratio as an independent prognostic factor for recurrence-free survival and overall survival(P < 0.05 for both). The concordance index of the nomograms, which included the tumorassociated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio, was 0.788(0.759) for recurrence-free survival(overall survival) and was higher than the concordance index of the traditional TNM staging system [0.672(0.663)].CONCLUSION The tumor-associated neutrophil-to-lymphocyte ratio is an independent prognostic factor in patients with gastric neuroendocrine neoplasms. Nomograms that include the tumor-associated neutrophil-to-lymphocyte ratio, Ki-67 index, and lymph node ratio have a superior ability to predict clinical outcomes of postoperative patients.
基金funded by the Joint Research Fund in Astronomy under cooperative agreement between the National Natural Science Foundation of China (NSFC)the Chinese Academy of Sciences (Grant Nos. U1631239 and U1831115)+1 种基金the NSFC (Grant No. 11603008)the Fundamental Research Funds for Central Universities to Harbin Engineering University
文摘Transmission efficiency(TE) and focal ratio degradation(FRD) are two important parameters for evaluating the quality of an optical fiber system used for astronomy. Compared to TE, the focal ratio is more easily influenced by external factors, such as bending or stress. Optical cables are widely implemented for multi-object telescopes and integral field units(IFUs). The design and fabrication process of traditional optical cables seldom considers the requirements of astronomical applications. In this paper, we describe a fiber bundle structure as the basic unit for miniaturized high-density FASOT-IFU optical cables,instead of the micro-tube structure in stranded cables. Seven fibers with hexagonal arrangement were accurately positioned by ultraviolet(UV)-curing acrylate to form the bundle. The coating diameter of a fiber is0.125 mm, and the outer diameter of the bundle is 0.58 mm. Compared with the 0.8 mm micro-tube structure of a traditional stranded cable, the outer diameter of the fiber bundle was reduced by 27.5%. Fiber paste was filled into the bundle to reduce stress between the fibers. We tested the output focal ratio(OFR) in95% of the encircled energy(EE95) of the fibers in the bundle under different conditions. With the incident focal ratio F/8, the maximum difference of OFR is 0.6. In particular, when the incident focal ratio is F/5,the maximum difference of OFR is only 0.1. The jacket formed by the UV-curing acrylate can withstand a certain stress of less than 1.38 N mm-1. The fiber bundle can maintain uniform emitting characteristics with a bending radius of 7.5 cm and with tension less than 6 N. The test results show that the structure of the fiber bundle can be used as a basic unit for miniaturized high-density astronomical optical cables.
基金Supported by Scientific and Technological Innovation Joint Capital Projects of Fujian Province,No.2016Y9031the General Project of Miaopu Scientific Research Fund of Fujian Medical University,No.2015MP021+2 种基金Youth Project of Fujian Provincial Health and Family Planning Commission,No.2016-1-41Fujian Province Medical Innovation Project,Chinese Physicians Association Young Physician Respiratory Research Fund,No.2015-CXB-16Fujian Science and Technology Innovation Joint Fund Project,No.2017Y9004
文摘BACKGROUND The incidence of proximal gastric cancer(GC)is increasing,and methods for the prediction of the long-term survival of proximal GC patients have not been well established.AIM To develop nomograms for the prediction of long-term survival among proximal GC patients.METHODS Between January 2007 and June 2013,we prospectively collected and retrospectively analyzed the medical records of 746 patients with proximal GC,who were divided into a training set(n=560,75%)and a validation set(n=186,25%).A Cox regression analysis was used to identify the preoperative and postoperative risk factors for overall survival(OS).RESULTS Among the 746 patients examined,the 3-and 5-year OS rates were 66.1%and 58.4%,respectively.In the training set,preoperative T stage(cT),N stage(cN),CA19-9,tumor size,ASA core,and 3-to 6-mo weight loss were incorporated into the preoperative nomogram to predict the OS.In addition to these variables,lymphatic vascular infiltration(LVI),postoperative tumor size,T stage,N stage,blood transfusions,and complications were incorporated into the postoperative nomogram.All calibration curves used to determine the OS probability fit well.In the training set,the preoperative nomogram achieved a C-index of 0.751[95%confidence interval(CI):0.732-0.770]in predicting OS and accurately stratified the patients into four prognostic subgroups(5-year OS rates:86.8%,73.0%,43.72%,and 20.9%,P<0.001).The postoperative nomogram had a C-index of 0.758 in predicting OS and accurately stratified the patients into four prognostic subgroups(5-year OS rates:82.6%,74.3%,45.9%,and 18.9%,P<0.001).CONCLUSION The nomograms accurately predicted the pre-and postoperative long-term survival of proximal GC patients.
基金Supported by Scientific and technological innovation joint capital projects of Fujian Province(2016Y9031)Construction Project of Fujian Province Minimally Invasive Medical Center(No.[2017]171)+4 种基金Project supported by the Science Foundation of the Fujian Province,China(Grant No.2018J01307)The second batch of special support funds for Fujian Province innovation and entrepreneurship talents(2016B013)Fujian province medical innovation project(2015-CXB-16)The Miaopu Fund for Scientific Research,Fujian Medical University(No.2014MP022)We thank Jun-Peng Lin for his assistance provided in patient screening and data input.
文摘Background:Little is known about the correlation between the clinicopathological features,postoperative treatment,and prognosis of multiple gastric cancers(MGCs).In this study,we aimed to investigate the correlation between these features and the impact of postoperative adjuvant chemotherapy on the long-term survival of patients with MGC.Methods:The clinical and pathological data of patients diagnosed with gastric adenocarcinoma who had radical gastrectomy from January 2007 to December 2016 were analyzed.Using propensity score matching,the prognostic differences,and the impact of postoperative adjuvant chemotherapy between those with MGC and solitary gastric cancers(SGC)were compared.Results:Among the 4107 patients investigated,the incidence of MGC was 3.2%(133/4107).Before matching,patients with MGC and SGC had disparities in the type of gastrectomy,pathological tumor stage(pT),pathological node stage(pN),and pathological tumor-node-metastasis stage(pTNM).After a 1:4 ratio matching,the clinical data of 133 cases of MGC and 532 cases of SGC were found to be comparable.The 5-year overall survival(OS)rate was 56.6%in the entire matched cohort,48.1%in the MGC group,and 58.7%in the SGC group(P=0.013).Multivariate analysis revealed that MGC,age,pT stage,pN stage,and adjuvant chemotherapy were independent predictors of OS(all P<0.05).Stratified analyses demonstrated that for the cohort of advanced gastric cancer(AGC)patients who did not had adjuvant chemotherapy,the 5-year OS rate of advanced cases of MGC was inferior than that of SGC patients(34.0%vs.46.1%,respectively;P=0.025)but there were no significant difference in the 5-year OS rate between advanced MGC and SGC patients who had adjuvant chemotherapy(48.0%vs.53.3%,respectively;P=0.292).Further,we found that the 5-year OS rate of advanced MGC who had adjuvant chemotherapy was significantly higher than those who did not had adjuvant chemotherapy(48.0%vs.34.0%,P=0.026).Conclusions:Patients with advanced MGC was identified as having a poorer survival as to SGC patients,but the implementation of postoperative adjuvant chemotherapy showed that it had the potential to significantly improve the long-term prognoses of MGC patients.
