Objective To expound emphatically the application of nuclear medical examination in primary hyperparathyroidism.Methods 22 patients (19 adenomas,3 hyperplasia) with primary hyperparathyroidism confirmed by clinical examination and surgery underwent the detection of parathormone (PTH) by immunoradiometric assay (IRMA) and double phase 99 Tcm-MIBI parathyroid imaging,of whom 15 performed 99 TcmO-4 thyroid imaging and 8 99 Tcm-MDP bone imaging.Results The level of serum PTH in all patients (428.21±256.48) was significantly higher as compared to normal value and in cases with adenomas (781.83±194.56) was markedly elevated.The sensitivity of 99 Tcm-MIBI early and delayed phase imaging in detecting lesions of parathyroid adenomas was 84.2% and 100%,respectively.The sensitivity in detecting lesions of hyperplasia was only 33.3%.With 99 Tcm-O-4 thryoid imaging,the cold nodules were present in 2 and normality in 13.As to bone imaging,the scans were abnormal in 7.Their severities on bone scintigraph were correlated with the duration of the disease.Conclusions The level of serum PTH detected by IRMA and double phase 99 Tcm-MIBI parathyroid imaging are both sensitive methods in qualitative diagnosis and localization of hyperthyroidism.99Tcm-MIBI imaging has limited value for detecting the hyperplasia.The thyroid and bone imaging may well improve the diagnostic sensitivity and accuracy,and reflect the stage and progress of hyperparathyroidism.

Objective To explore the clinical significance of laparoscopic exploration in non-traumatic acute abdomen disease.Methods Four hundred and fourteen cases of non-traumatic acute abdomen disease patients with unknown determine diagnosis from June 2016 to May 2018 in Department of General Surgery,First Medical Center of Chinese PLA General Hospital were reviewed,among which 278 were males and 136 were females,aged (47.6 ± 7.3) years (range,7-96 years).According to the case for natural order,the patients can be divided into laparoscopic and open surgery group in accordance with the operation records,in which included laparoscopic group 297 examples and open surgery group 117 examples.Operation methods of two groups were chosen on the basis of clear pathogeny and patient condition.Then the outcome of intraoperative and postoperative of two groups were compared and analyzed.Intraoperative outcome index mainly includes:operation time,blood loss and surgical incision length,etc..Postoperative outcome index mainly includes:length of hospital stay,ICU transition time,days of analgesic drug used,hospitalization expenses,intestinal ventilation timing and incision infection rate,etc..Measurement data with normal distribution were represented as mean ± standard deviation (Mean ± SD) and analyzed by matching t test after logistic correction.Comparison between groups of count data was done using the chi-square test.Results In laparoscopic group,intraoperative blood loss,surgical incision length,length of hospital stay,days of analgesic drug used,hospitalization expenses,intestinal ventilation timing,liquid timing,postoperative incision infection rate were:(23.881 ± 12.164) ml,(4.561 ± 1.343) cm,(5.419±0.732) d,(2.831 ±1.453) d,(3.895 ±1.842) ten thousandyuan,(1.891 ±0.654) d,(2.218± 0.395) d,2.02％ (6/297),respectively.The same index of open surgery group were:(84.673 ± 27.662) ml,(12.385 ±3.492) cm,(7.356 ± 1.342) d,(5.676 ± 2.335) d,(5.781 ± 2.467) ten thousand yuan,(2.772 ± 1.033) d,(3.091 ± 0.578) d,17.95％ (21/117),respectively.The indexes of the laparoscopic group were better than those of the open surgery group.The difference between the two groups was statistically significant(P ＜ 0.05).Conclusion For its timely diagnosis,minimally invasive treatment and fast recovery,laparoscopic exploration is of great value in non-traumatic acute abdomen disease patients with unknown determine diagnosis,which is worthy of popularization and application.

Objective To analyze and compare the complications of laparotomysurgery and laparoscopic surgery for upper gastrointestinal perforation.Methods Retrospective analyzed the clinical data of 113 patients,including 100 male cases,13 female cases,aged 17 to 87 years old,mean (51.42 ± 17.11) years old,with perforation in stomach and duodenum at Chinese People's Liberation Army General Hospital from January 2008 to January 2017.The patients were divided into laparotomy group (64 cases) and laparoscopic group (49 cases) according to the operation mode,and the intraoperative blood loss and postoperative complications were compared.The measurement data were expressed by ((-x) ± s),and the t test was used between the groups.The count data were expressed by ratio or percentage,the chi-square test was used.Results The amount of bleeding in laparoscopic group was (51.90 ± 18.91) ml,was significantly less than that of laparotomy group (74.60 ± 10.23) ml (x2 =8.186,P =0.000).Postoperative complications occurred in 28 patients (24.8％) in 113 patients,and the top three complications were incision infection,pneumonia,and anastomotic or patch bleeding.The incidence of postoperative complications in laparotomy group and laparoscopic group was 29.7％ (19/64) and 18.4％ (9/49),respectively,and there was no significant difference (x2 =1.908,P =0.193).Conclusion The two kinds of operation methods of upper digestive tract perforation are similar,and the amount of bleeding in laparoscopic operation group is less than that in laparotomy group,at the same time,higher technical requiremnents are need to be completed by experienced doctors for minimally invasive surgery.

Objective To study the effect of applying a new intravenous resuscitation solution to electrolyte imbalance in miniature pigs after seawater immersion injury.Methods A total of 20 Guizhou Ⅲ type miniature pigs aged 4 months were randomly divided to A and B groups,10 in each.The seawater immersion injury model was used to soak sea water for 3 hours.The changes of electrolytes in miniature pigs before and after soaking wererecorded.A group with intravenous infusion of 0.9％ sodium chloride solution,and B group with new type ofrecovery liquid intravenous rehydration.Electrolyte changes after infusion were recorded and analyzed.Data ofnormal distribution measurement data were expressed as ((x) ± s).The data of electrolyte before and after immersionwere analyzed by paired t test.After soaking,the relative data of electrolyte after sub-group rehydration wereanalyzed by independent sample t test.Results After seawater immersion,pH value were dropped from 7.39 ±0.06and 7.39 ±0.04 to 7.32 ±0.05 and 7.33 ±0.05,serum K + concentration elevated from (3.93 ±0.38) mmol/Land (3.93±0.42) mmol/L to (4.35 ±0.33) mmol/L and (4.37 ±0.14) mmol/L.Clconcentration increased from (93.38 ± 4.29) mmol/L and (92.88 ± 3.79) mmol/L to (102.80 ± 4.29) mmol/Land (103.50±2.46) mmol/L.Na+ concentration in serum were dropped from (140.64 ± 4.99) mmol/L and(140.69 ±4.72) mmol/L to (136.80 ±4.32) mmol/L and (136.90 ±3.03) mmol/L.After normal saline andnew type of recovery liquid rehydration respectively,group B with new recovery liquid,pH increased from 7.33 ±0.05 to 7.38 ±0.04 (P ＜0.05),serum concentration of K+ and Cl-concentration were dropped from (4.37 ±0.14) mmol/L and (103.50 ±2.46) mmol/L to (3.87 ±0.25) mmol/L and (94.15 ±4.23) mmol/L (P =0.005,P =0.007).The concentration of serum Na + back up from (136.90 ± 3.03) mmol/L to (139.30 ±3.06) mmol/L (P =0.038).A group of saline infusion after the various indicators did not change significantly.Conclusion The new intravenous resuscitation solution of miniature pigs electrolyte imbalance correction effect issignificant,that the resuscitation solution has some clinical value for seawater immersion iniurv.

Objective: To explore the clinicopathological characteristics and prognostic factors of patients with ovarian metastasis from gastric cancer. Methods: We retrospectively analyzed the clinical data and treatment strategies of 83 patients with metastatic ovarian tumors treated at PLA General Hospital between January 2006 and December 2017. Univariate analysis using the Log-rank test and multivariate analysis using the Cox proportional-hazards model were used to identify the prognostic factors. Results: The median diam-eter of the metastatic ovarian tumors was 7.1 (1.0-24.0) cm. Of these patients, 36 (43.4%) had unilateral metastasis and 47 (56.6%) had bilateral metastasis; 35 (42.2%) patients had peritoneal metastasis. All patients received chemotherapy, including 57 (68.7%) pa-tients who underwent combined-modality resection of the metastatic tumors and 22 patients (26.5%) who received hyperthermic in-traperitoneal chemotherapy. Of these patients, 74 (89.1%) were followed up, with a median survival time of 15 [95% confidence inter-val (CI): 12.5-17.5] months. The 1-year, 3-year, and 5-year overall survival rates were 71.1%, 6.5%, and 0, respectively. Univariate analy-sis showed that risk factors including≥6 metastatic lymph nodes, metastasectomy, synchronous ovarian metastasis, peritoneal carcino-matosis, estrogen receptor (ER) positivity, and high levels of serum carcinoembryonic antigen and cancer antigen-125 (CA125) might af-fect the prognosis (P<0.05). Multivariate analysis showed that metastasectomy, synchronous ovarian metastasis, combined peritoneal carcinomatosis, and ER positivity were independent factors affecting prognosis (P<0.05). Conclusions: We found that the presence of synchronous ovarian metastasis or combined peritoneal carcinomatosis indicated a poor prognosis; in contrast, ER-positivity predicted a better prognosis than ER-negativity. Metastasectomy may prolong the survival of patients.

OBJECTIVETo investigate and compare the clinicopathological characteristics of gastric stump cancer(GSC) and the recurrent of gastric cancer (RGC) following radical gastrectomy, and to evaluate survival prognosis.

METHODSA retrospective cohort study was performed on clinicopathological and survival data of patients with GSC (n=31) and with RGC (n=105) following radical gastrectomy at the Chinese People's Liberation Army General Hospital between January 1992 and August 2017. GSC was defined as cancer occured in remnant stomach ≥10 years after radical gastrectomy, while RGC was defined as <10 years. Patients of both groups received radical resection or palliative operation with tumor resection and had complete clinicopathological data regarding the first operation and gastric stump operation. T-test was used to compare quantitative data between the two groups, and Pearson χ test was used to compare qualitative data between the two groups. Kaplan-Meier method was applied to draw survival curves and log-rank test to assess survival differences.

RESULTSOf the 136 enrolled patients, 113 were male and 23 were female. In the first operation, compared with RGC group, in GSC group, the Borrmann type and histological differentiation were more better [Borrmann I(: 11/31 (35.5%) vs. 5/105 (4.8%), χ=23.003, P=0.001; the high differentiation: 15/31 (48.4%) vs. 1/105 (1.0%), χ=57.137, P=0.001]; the tumor diameter was smaller [<4 cm: 28/31(90.3%) vs. 56/105(53.3%), χ=14.045, P=0.001]; the pT stage [pT1: 12/31 (38.7%) vs. 3/105 (2.9%), χ=50.373, P=0.001], pN stage [pN0: 28/31 (90.3%) vs. 19/105 (18.1%), χ=55.722, P=0.001] and pTNM staging [I(: 26/31 (83.9%) vs. 11/105 (10.5%), χ=66.688, P=0.001] were earlier. Most of the GSC occurred at non-anastomotic sites, while the recurrence mostly occurred at anastomotic sites [51.6%(16/31) vs. 61.9%(65/105), χ=7.520, P=0.023]. Compared with RGC group, GSC group had better histological differentiation [high differentiation: 5/31 (16.1%) vs. 2/105(1.9%), χ=10.029, P=0.007]. There was more histological type change between the first and the second operation in GSC group than that in RGC group[48.4%(15/31) vs. 26.7%(28/105), χ=5.222, P=0.022]. The overall survival time of GSC group was significantly longer than that of RGC group [mean: (161.0±18.6) months vs. (50.8±27.6) months, respectively, Log-rank: 76.818, P=0.001]. The survival time after the second surgery of GSC group was longer than that of RGC group [mean: (30.7±18.4) months vs. (20.5±15.0) months, P=0.003]. In the subgroup analysis of all the 136 patients according to histological type change between the two surgeries (unchanged 93 patients, changed 43 patients), compared with unchanged group, the overall survival time of changed group was longer [mean: (99.6±56.5) months vs. (72.1±58.1) months, P=0.008].

CONCLUSIONSGSC patients have better histological differentiation and earlier clinical stage of primary gastric cancer, and longer survival time compared with RGC patients. The histological type change between two operations may be used as a new factor to define GSC.

Female ; Gastrectomy ; Gastric Stump ; pathology ; surgery ; Humans ; Male ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Survival Rate

Objective To analyze the occurrence and clinical significance of hypophosphatemia after mod-erate-to-major abdominal surgery. Methods A total of 120 patients who had received moderate to major abdominal surgery and then transferred to the intensive care unit ( ICU) from January 2008 to October 2018 were retrospectively analyzed. The peri-operative parameters of serum inorganic phosphate and calcium levels were recorded and analyzed. The incidence of hypophosphatemia after the operation was calculated. The effect of phosphorus-supplement infusion on the complications and mortality within 30 days after the operation were observed. Results After moderate-to-major surgery, the phosphorus concentration significantly decreased [ (1. 21±0. 27) vs. (0. 83±0. 24) mmol/L, P<0. 05];the incidence of hypophosphatemia was 58. 3％, especially in patients with nutritional risk assessed before the operation. The post-operative complications were less in the phosphorus-supplement infusion group than in the control group (17. 5％vs. 41. 3％, P=0. 028). Conclusion The incidence of hypophosphatemia is relatively high after moderate-to-major abdominal surgery, especially in patients with nutritional risks. The treatment of phosphorus-sup-plement infusion can benefit the patients in their short-term prognosis.

Objective:To investigate the prognosis of patients with initially resectable gastric cancer liver metastasis (GCLM) who were treated by different modalities, and analyze the influencing factors for prognosis of patients.Methods:The retrospective cohort study was conducted. The clinicopathological data of 327 patients with initially resectable GCLM who were included in the database of a nationwide multicenter retrospective cohort study on GCLM based on real-world data from January 2010 to December 2019 were collected. There were 267 males and 60 females, aged 61(54,68)years. According to the specific situations of patients, treatment modalities included radical surgery combined with systemic treatment, palliative surgery combined with systemic treatment, and systemic treatment alone. Observation indicators: (1) clinical characteristics of patients who were treated by different modalities; (2) prognostic outcomes of patients who were treated by different modalities; (3) analysis of influencing factors for prognosis of patients with initially resectable GCLM; (4) screening of potential beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. The Kaplan-Meier method was used to calculate survival rate and draw survival curve, and Log-Rank test was used for survival analysis. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. The propensity score matching was employed by the 1:1 nearest neighbor matching method with a caliper value of 0.1. The forest plots were utilized to evaluate potential benefits of diverse surgical combined with systemic treatments within the population. Results:(1) Clinical characteristics of patients who were treated by different modalities. Of 327 patients, there were 118 cases undergoing radical surgery plus systemic treatment, 164 cases undergoing palliative surgery plus systemic treatment, and 45 cases undergoing systemic treatment alone. There were significant differences in smoking, drinking, site of primary gastric tumor, diameter of primary gastric tumor, site of liver metastasis, and metastatic interval among the three groups of patients ( P<0.05). (2) Prognostic outcomes of patients who were treated by different modalities. The median overall survival time of the 327 pati-ents was 19.9 months (95% confidence interval as 14.9-24.9 months), with 1-, 3-year overall survival rate of 61.3%, 32.7%, respectively. The 1-year overall survival rates of patients undergoing radical surgery plus systemic treatment, palliative surgery plus systemic treatment and systemic treatment alone were 68.3%, 63.1%, 30.6%, and the 3-year overall survival rates were 41.1%, 29.9%, 11.9%, showing a significant difference in overall survival rate among the three groups of patients ( χ2=19.46, P<0.05). Results of further analysis showed that there was a significant difference in overall survival rate between patients undergoing radical surgery plus systemic treatment and patients undergoing systemic treatment alone ( hazard ratio=0.40, 95% confidence interval as 0.26-0.61, P<0.05), between patients undergoing palliative surgery plus systemic treatment and patients under-going systemic treatment alone ( hazard ratio=0.47, 95% confidence interval as 0.32-0.71, P<0.05). (3) Analysis of influencing factors for prognosis of patients with initially resectable GCLM. Results of multivariate analysis showed that the larger primary gastric tumor, poorly differentiated tumor, larger liver metastasis, multiple hepatic metastases were independent risk factors for prognosis of patients with initially resectable GCLM ( hazard ratio=1.20, 1.70, 1.20, 2.06, 95% confidence interval as 1.14-1.27, 1.25-2.31, 1.04-1.42, 1.45-2.92, P<0.05) and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy were independent protective factors for prognosis of patients with initially resectable GCLM ( hazard ratio=0.60, 0.39, 0.46, 95% confidence interval as 0.42-0.87, 0.25-0.60, 0.30-0.70, P<0.05). (4) Screening of potentinal beneficiaries in patients who were treated by radical surgery plus systemic treatment and patients who were treated by palliative surgery plus systemic treatment. Results of forest plots analysis showed that for patients with high-moderate differentiated GCLM and patients with liver metastasis located in the left liver, the overall survival rate of patients undergoing radical surgery plus systemic treatment was better than patients undergoing palliative surgery plus systemic treatment ( hazard ratio=0.21, 0.42, 95% confidence interval as 0.09-0.48, 0.23-0.78, P<0.05). Conclusions:Compared to systemic therapy alone, both radical and palliative surgery plus systemic therapy can improve the pro-gnosis of patients with initially resectable GCLM. The larger primary gastric tumor, poorly differen-tiated tumor, larger liver metastasis, multiple hepatic metastases are independent risk factors for prognosis of patients with initial resectable GCLM and immunotherapy or targeted therapy, the treatment modality of radical or palliative surgery plus systemic therapy are independent protective factors for prognosis of patients with initially resectable GCLM.

Objective: To investigate clinicopathological features and prognostic factors of gastric neuroendocrine tumors (G-NEN). Methods: Clinical and pathological data of patients with G-NEN diagnosed by pathological examination in Chinese PLA General Hospital from January 2000 to June 2018 were retrospectively analyzed in this case-control study. Patients with complicated visceral lesions, other visceral primary tumors, mental disorders and incomplete clinicopathological data were excluded. Finally, 240 hospitalized patients who met the inclusion criteria were enrolled. Physical examination information, tumor characteristics and pathological characteristics of patients were summarized. The Cox regression models were used to analyze the risk factors affecting G-NEN and the survival conditions were described by Kaplan-Meier survival curves and log-rank test. Results: In 240 patients with G-NEN, the mean age was (60.3±10.1) years; 181 were male (75.4%) and 59 females (24.6%); mean tumor diameter was (4.2±2.8) cm; 51 cases (21.2%) were neuroendocrine tumor (NET), 139 cases (57.9%) neuroendocrine carcinoma (NEC), 50 cases (20.8%) mixed neuroendocrine carcinoma (MANEC); 28 cases (11.7%) were G1 low grades, 34 cases (14.2%) G2 medium grades, and 178 cases (74.2%) G3 high grades; tumor infiltration depth T1 to T4 were 44 cases (18.3%), 27 cases (11.2%), 60 cases (25.0%) and 109 cases (45.4%) respectively; 163 cases (67.9%) developed lymphatic metastasis and 46 patients (19.2%) distant metastasis; tumor stage from stage I to stage IV were 55 cases (22.9%), 42 cases (17.5%), 94 cases (39.2%) and 53 cases (22.1%) respectively. Of the 240 G-NEN patients, 223 cases (92.9%) were followed up. The median survival time of the patients was 39.2 (95% CI: 29.1 to 47.5) months. Univariate survival analysis showed that age ≥ 60 years, tumor diameter ≥ 4.2 cm, tumor grade G3, lymphatic metastasis, distant metastasis, and tumor stage III-IV were risk factors for G-NEN patients. Multivariate survival analysis revealed that lymphatic metastasis (HR=1.783, 95%CI: 1.007-3.155, P=0.047) and distant metastasis (HR=2.288, 95% CI: 1.307-4.008, P=0.004) were independent risk factors of the prognosis. Further analysis of the G3 subgroup of G-NEN showed that the 5-year survival rate of NET-G3 was 76.19%, which was significantly higher than that of NEC-G3 and MANEC-G3 (15.60% and 24.73%, P=0.012). Conclusions Most G-NEN patients are in advanced stage at diagnosis. Lymphatic metastasis and distant metastasis indicate poor prognosis. The prognosis of high proliferation NET-G3 patients is better as compared to those of NEC-G3 and MANEC-G3. This classification is worth further attention.