Objective To compare the number of lymph node dissected by intraoperative lymphatic mapping guided D2 gastrectomy and that by standard D2 gastrectomy plus lymphadenectomy in patients of advanced gastric cancer. Methods In this study 20 advanced gastric cancer cases received intraoperative peritumor injection of carbon nanoparticles suspension ( group 1 ) and D2 lymphadenectomy was guided by the black-stained lymph nodes. 21 cases undergoing standard D2 lymphadenectomy served as controls (group 2). The number of lymph nodes removed and the condition of lymphatic metastasis in two groups, blackstained lymph nodes in group 1, and postoperative complications were compared. Results The average lymph nodes dissected in group 1 (35. 1 ± 13.4) were higher than in control group (26.2 ±7.8). The differences were statistically significant (t =2. 126, P =0. 034). The number of removed N2 and N3 lymph nodes in group 1 were more than that in control group. The total black-stained ration of lymph nodes was 52. 7% in group 1. The positive rate of lymph nodes was higher in black-stained lymph nodes (27.6%) than in unstained lymph nodes ( 10. 8% ) in group 1 and in control group ( 16. 9% ). The differences were also statistically significant ( x2 = 6. 034, P = 0. 016; x2 = 5. 142, P = 0. 023 ). Postoperative afferent loop obstruction developed in one case in group 1. Conclusions Lymphatic mapping guided D2 radical gastrectomy plus lymphadenectomy increases the number of lymph nodes dessected and improves the efficiency of positive lymph nodes excision for patients of advanced gastric cancer.

BACKGROUND: Recently simvastatin has been shown to stimulate osteogenic differentiation and bone formation, but there is no report about the effect of simvastatin on the bone development of young rats.OBJECTIVE: To evaluate the effects of simvastatin on osteogenic relative genes of proximal tibia trabecular bone and osteogenic differentiation of bone marrow stromal cells (BMSCs).METHODS: Twenty 1-week-old Spragua-Dawley young rats were randomly and equally divided into simvastatin and control groups. Rats in the simvastatin group were treated with a subcutaneous injection of simvastatin[5 mg/(kg·d)] for 2 weeks, while rats in the control group were treated with placebo for 2 weeks. The expressions of bone morphogenetic protein-2 (BMP-2), matrix metalloproteinase-13 (MMP-13), and vascular endothelial growth factor (VEGF) of trabecular bone in the tibia were analyzed by mmunohistochemicel staining. BMSCs harvested from the rat femur were osteogenic-differentiation cultured. Alkaline phosphatase (ALP) staining was performed on day 14, real-time PCR analysis was applied to investigate the BMP2, RUNX2,Osterix, MSX2, DLX3, DLX5 mRNA expressions during osteogenic differentiation in vitro on day 21, and von Kossa staining was detected on day 28.RESULTS AND CONCLUSION: ① There was no significant difference in the expressions of BMP-2, MMP-13, and VEGF between simvastatin and control groups. ② The percentages of ALP positive-stained cells were about 30% and there was no significant difference between the two groups (P ＞ 0.05). ③There was no significant difference in the expressions of BMP-2,RUNX2, Osterix, MSX2, DLX3, DLX5 mRNA in osteoganic differentiation-induced BMSCs. ④ von Kossa staining demonstrated that dark brown calcified spots in various sizes were observed, but there was no significant difference in size and density between simvastatin and control groups. A subcutaneous injection of simvastatin[5 mg/(kg·d)] for 2 weeks could not remarkably affect osteogenic relative genes of bone trabecula and osteogenic differentiation of BMSCs.

Objective To evaluate the effect of simulated training on in-service physicians electrocardiogram(ecg) theory and operational learning effect.Methods Sixty resident doctors were randomly divided into experiment group (n=30) and control group(n=30).The experimental group adopted teaching + simulation training mode to implement the theory and operation of ECG in continuing while the control group were taught only by lectures.Training effect of both groups was assessed by electrocardiogram theory and operation examination before and after training respectively,and by questionnaires at the end of the training as well.Data of the examination and questionnaires were analyzed by t test or x2 test.P＜0.05 was considered statistically significant.Results After training,the score of theory examination was (90.87 ± 6.67) points in experiment group and was (85.83 ± 5.5) points in control group,with statistical difference between these two groups(t=3.201,P=0.003).Score of operation examination was(93.40 ± 4.31) points in experiment group and was(77.03 ± 7.96)points in control group,with significant differences(t=10.204,P=0.000).The satisfaction degree of enhancing learning interest,theoretical knowledge and operation skill,and strengthening the concept of humauistic care were significantly better in the experiment group than in the control group (x2=34.737,6.405,42.088,41.713,P=0.000,0.011,0.000,0.000).Conclusions Application of simulated training in the study of electrocardiogram is obviously superior in effect to the traditional teaching model.It can improve the theoretical knowledge and operation skill,which is helpful in elevating the in-service physicians' comprehensive capability.

Objective:To investigate the clinical efficacy of ultrasound-guided vacuum-assisted excision (VAE) in the treatment of breast benign phyllode tumor and the risk factors of local recurrence after operation.Methods:A total of 256 cases of patients with breast benign phyllode tumor admitted to Yuncheng Central Hospital from January 2012 to January 2020 were included in the retrospective study, they were all female, of which 160 cases received ultrasound-guided VAE surgical treatment and 96 cases received open surgical treatment. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups. The Chi-square test or Fisher exact probability method was used to compare the data groups. Univariate analysis was performed on the factors related to the local recurrence of benign phyllode tumor after surgery, and then the factors with statistically significant differences in the univariate analysis were further incorporated into multivariate Logistic regression analysis. Results:Univariate analysis results showed that the maximum diameter of tumor ≥25 mm and the history of ipsilateral breast fibroadenoma were associated with postoperative local recurrence of breast benign phyllodes tumor ( P<0.05). Multivariate Logistic regression analysis results showed that tumor diameter ≥25 mm was an independent risk factor for postoperative local recurrence of breast benign phyllodes tumor ( P<0.05). Conclusion:Ultrasound-guided VAE in the treatment of breast benign phyllodes tumor patients with maximum diameter less than 25 mm can reduce the postoperative local recurrence rate, and patients with tumor maximum diameter greater than 25 mm should have the higher local recurrence risk.

Objective:To analyze the tendency of elderly patients with breast cancer in the choice of treatment methods and related influencing factors.Methods:The data of 312 elderly patients with unilateral breast cancer treated in Yuncheng Central Hospital from January 2013 to December 2017 were collected for retrospective analysis. All patients' treatment options were analyzed, and the age of patients who chose different treatment options was compared. Univariate and logistic regression were used to analyze the chemotherapy choice tendency of elderly breast cancer patients, and Cox proportional risk model was used to analyze the influencing factors of 5-year survival of elderly breast cancer patients.Results:In the whole patient population, the selection rates of surgery, chemotherapy, radiotherapy, endocrine therapy and targeted therapy were respectively 97.44% (304/312), 81.41% (254/312), 7.05% (22/312), 68.27% (213/312), 3.85% (32/312). The mean age of all patients was (67.94±6.55) years. There were no statistically significant differences in the age of patients with different treatment methods (all P>0.05). The results of univariate analysis showed that, there were statistically significant differences in the depth of invasive cancer ( t=3.11, P=0.002), number of axillary lymph node metastasis ( t=6.54, P<0.001), comorbidities ( t=-4.85, P<0.001) and Eastern Cooperative Oncology Group (ECOG) score ( t=-4.56, P<0.001) between chemotherapy and non-chemotherapy patients, and there were no statistically significant differences in age ( t=-0.52, P=0.604), pathological type ( χ2=4.96, P=0.084), surgical type ( χ2=0.21, P=0.899), tumor differentiation degree ( χ2=3.28, P=0.194), estrogen receptor ( χ2=0.99, P=0.321), progesterone receptor ( χ2=0.89, P=0.346), and human epidermal growth factor receptor-2 ( χ2=0.58, P=0.445). The results of multifactor analysis showed that types of comorbidities ( OR=0.91, 95% CI: 0.85-0.99, P=0.024) and ECOG score ( OR=0.95, 95% CI: 0.92-0.99, P=0.007) were independent influencing factors for the use of chemotherapy after surgery in elderly breast cancer patients. A total of 74 patients died within 5 years after surgery, and the 5-year overall survival rate was 76.28%. More axillary lymph node metastasis ( RR=1.26, 95% CI: 1.09-1.46, P=0.001) and more complications ( RR=1.07, 95% CI: 1.02-1.13, P=0.007) were risk factors for prognosis. Conclusion:Surgery and chemotherapy are the main treatment methods for elderly patients with breast cancer. ECOG score and number of complications can directly affect the results of chemotherapy selection for such patients, the number of axillary lymph node metastasis and complications had significant influence on the long-term survival of the patients.

Objective: To systematically review the quality and reporting quality of colorectal cancer screening guidelines, and to provide reference for the update of colorectal cancer screening guidelines and colorectal cancer screening in China. Methods: "Colorectal cancer", "colorectal tumor", "screening", "screening", "guide", "consensus", "Colorectal cancer", "Colorectal neoplasms", "Screening", "Early Detection of Cancer", "Guideline" and "recommendation" were used as search keywords. The literature retrieval for all the Chinese and English guidelines published before April 2018 was conducted by using PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, China Biology Medicine disc (CBMdisc), Cochrane Library, Guideline International Network, China Guidelines Clearinghouse (CGC) and the official website of the US Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), International Agency for Research on Cancer (IARC), Australia Cancer Council (ACC) and Association of Coloproctology of Great Britain & Ireland (ACPGBI). The inclusion criteria were independent guidance documents for colorectal cancer screening. The language is limited to Chinese and English. The exclusion criteria were literature on interpretation, evaluation, introduction, etc., as well as the translated version of the guide and old guides. The quality and reporting norms of colorectal cancer screening guidelines were compared and evaluated using the European Guideline Research and Assessment Tool (AGREE Ⅱ) and the Practice Guideline Reporting Standard (RIGHT). Results: A total of 15 guides were included. The results of the AGREE Ⅱ quality evaluation showed that the overall quality of 15 guides was high. Among them, there were 9 guides with an overall score of 50 or more, 10 with a recommendation level of "A", and 2 with a rating of "B". There were 3 guides for "C"; each guide scores higher in scope and purpose, and clarity, and scores vary greatly in the areas of participants, rigor, applicability, and independence. The results of the RIGHT evaluation showed that 15 guides were insufficient in six areas except for background information, evidence, recommendations, reviews and quality assurance, funding and conflict of interest statements and management, and other aspects. Conclusion The overall quality of included guidelines for colorectal cancer screening is high, but the normative nature needs to be strengthened.