Objective To compare the efficacy and safety between postoperative chemoradiotherapy and postoperative chemotherapy alone in patients with gastric cancer by a meta-analysis of randomized controlled trials (RCTs).Methods Chinese Scientific Journal Full-Text Database (January 1979-June 2013),VIP (January 1989-June 2013),Chinese Biomedical Literature Database (January 1978-June 2013),Cochrane Library (Issue 6,2013),PubMed (January 1966-June 2013),and EMBASE (January 1974-June 2013) were searched to identify RCTs of postoperative chemoradiotherapy versus chemotherapy alone in patients with gastric cancer.The obtained data were analyzed using RevMan 5.2 and Stata 12.The difference between two groups was estimated by calculating the risk ratio (RR) with 95％ confidence interval (CI).Results A total of 1 143 patients from 11 RCTs were included in the meta-analysis according to the inclusion and exclusion criteria.Our results showed that postoperative chemoradiotherapy significantly increased 1-,2-,and 3-year overall survival rates (RR =1.20,95％ CI=1.10-1.30,P=0.00; RR =1.34,95％ CI=1.16-1.56,P=0.00; RR =2.62,95％ CI=1.72-3.97,P=0.00) and 3-and 5-year disease-free survival rates (RR =1.10,95 ％ CI =1.00-1.21,P =0.04; RR =1.27,95％ CI =1.02-1.60,P =0.04).The incidence of grade 3 or 4 gastrointestinal tract reactions,liver function impairment,bone marrow suppression,and hand-foot syndrome was low and showed little difference between two groups (P =0.03-0.78).Conclusions Postoperative chemoradiotherapy can prolong the survival of patients with gastric cancer,and the patients have good tolerance to chemotherapy drugs.

Objective To quantitatively evaluate the association between Ile105Val polymorphism of glutathione S-transferase pi (GSTP1) and sensitivity to platinum-based chemotherapy in advanced gastric cancer.Methods The relevant published literatures about Ile105Val polymorphism of GSTP1 and sensitivity to platinum-based chemotherapy in gastric cancer were retrieved from China National Knowledge Internet (CNKI),VIP,Chinese Biomedical Literature Data (CBM),Wan-Fang databases,PubMed,EMBASE and Cochrane Library.Clinical response (complete response and partial response) was employed to estimate chemosensitivity.Meta-analysis was conducted by the RevMan 5.2 software,odds ratio (OR) with 95％ confidence interval (CI) were calculated.Publication bias was identified using Stata 12.0 software.Results A total of 724 cases from 6 case-control trials were included.The results of Meta-analysis showed the different statistical significance was found between GSTP1 Ilel05Val polymorphism and clinical response in the follow genotypes [GG+GA vs AA:OR =2.38,95％CI (1.29 ～4.38); GG vs GA + AA:OR =3.66,95％CI (1.18 ～11.39) ; GG vs AA:OR =4.42,95％ CI (1.28 ～ 15.26)] and Asian population subgroups [GG + GAvs AA:OR =2.93,95％ CI (1.33 ～ 6.48)].Conclusion Polymorphism of GSTP1 Ile105Val(A/G) may be associated with platinum-based chemosensitivity in advanced gastric cancer.

Objective To investigate the effect of alpha 1-antitrypsin (A1AT) concerning in reducing the injury of transplanted islets by pancreas exocrine cells and promoting proliferation of the pancreas B cells.Method The pancreases of mice were digested with collagenase,islets were isolated artificially,and pancreatic exocrine cells were collected.In purified islet group (n =6),100 islets were seeded into a 6 well culture plate.In experimental group(n =6),100 islets were co-cultured with equal volume of pancreas exocrine cells,and 0.5 mg/mL A1AT was added into a 6-well culture plate.In control group(n =6),100 islets were co-cultured with equal volume of pancreas exocrine cells.After 48 h,insulin content of islets in each well and trypsin concentration in the supernatant of each well were measured.The islets were cultured in low sugar and high sugar 1640 medium,then glucose stimulated insulin secretion (GSIS) test was carried out.In vivo,8-9-week old male BALB/C mice were induced with STZ (190 mg/kg body weight,i.p) to establish the diabetic model and randomly divided into two groups.In experimental(n =10) and control(n =10) groups,250 islets and the equal volume of pancreatic exocrine cells were transplanted into different regions of left kidney subcapsule,resepctively.The experimental group was injected with A1AT (83 mg/kg,qd,i.p) for 28 days after operation,and the control group was injected with the same amount of normal saline (qd,i.p) for 28 days.Both two groups were given EDU (5 μg/g,qd,i.p) for 28 days.The blood glucose level was monitored continually.Nephrectomies were performed after 28 days.The expression of anti-amylase antibodies in the renal subcapsule was detected by immunohistochemical staining,and the proliferation of islet beta cells was examined using immunofluorescence staining.Result Insulin levels and insulin stimulation index in the control group were decreased as compared with those in the purified islet group; those in the experimental group were higher than in the control group,but lower than in the purified islet group.Trypsin concentration in the control group was increased as compared with the purified islet group,that in the experimental group was lower than the control group,but higher than in the purified islet group (all P＜0.01).After islets transplantation,the blood glucose levels in control and experimental groups were normal,but those in the control group recovered later than in the experimental group (P＜0.01).At 3rd day after nephrectomy,the blood glucose levels were ＞21 mmol/L in both two groups.A large number of anti-amylase antibody-positive cells were found in the renal subcapsule in the control group while little seen in the experimental group after 28 days.The immunofluorescence showed that the insulin +/EDU + B cells in the experimental group were more than those in the control group.Conclusion Conclusion Co-culture of islets and pancreatic exocrine cells with A1AT can prevent islet cells from damage caused by trypsin.A1AT could inhibit the secretion of pancreatic amylase from pancreatic acinar cells and promote proliferation of islet beta cells.

Objective: To explore the impact role of Mandibular Distraction Osteogenesis technique (MDO) on the health quality of life in children with Pierre-Robin Sequence (PRS). Methods: From January 2017 to August 2017, 44 cases of children with PRS admitted in children′s hospital of Nanjing Medical University were recruited. Glasgow Children′s benefit inventory(GCBI), Chinese version was used to study postoperative qualify of life in four aspects: physiology, emotions, learning, and vitality. Clinical data and the quality of life score were collected from the patients, and comparison analysis was performed. Results: GCBI total score of the 44 cases of PRS treated with MDO surgery was 46, indicating that the overall quality of life was improved; Physical dimension score was 72, which was the highest, showing the most positive changes. GCBI total scores for the children with different types of PRS were type Ⅰ62, type Ⅱ43, type Ⅲ18, respectively. Nonparametric test showed that quality of life in typeⅠpatients was improved compared to typeⅢ. The difference was statistically significant (Z = -3.34, P=0.01). For the comparisons between type Ⅰ and Ⅱ and type Ⅱ and type Ⅲ, there was no statistically significant difference (P>0.05). Conclusions MDO plays a positive role in improving life of quality . Physiological conditions were the aspects that were improved most. The milder the case is, the more the postoperative quality of life is improved.

Objective:To investigate the efficacy of two-way needle suture technique (TNST) in the minimally invasive repair of acute closed Achilles tendon rupture.Methods:From June 2019 to June 2021, 26 patients with acute closed Achilles tendon rupture were treated at Zhengzhou Orthopedic Hospital. They were 20 males and 6 females, with a mean age of 28 (23, 31) years. The rupture end was (4.2±1.3) cm away from the calcaneal insertion, and the interval from injury to operation 4.3 (2.0, 5.0) d. Preoperative MRI examinations revealed in all the patients closed Achilles tendon rupture which was to be repaired by TNST. The operation time, incision length, incidence of complications, ankle dorsiflexion and plantar flexion were recorded. The Arner-Lindholm scoring was used to evaluate the clinical efficacy.Results:The operation time was (20.0±5.0) min and the incision length (2.5±0.4) cm. Postoperatively, all incisions healed by the first stage, with no complications like incision infection, skin edge necrosis, deep vein thrombosis at lower limbs, injury to the sural nerve, or re-rupture of the Achilles tendon. All patients were followed up for (12.0±6.0) months. At the last follow-up, the patients walked normally, their incisions healed well, the continuity of the Achilles tendon was good by palpation, their heel lift was strong, and all their activities were restored to the levels before rupture of the Achilles tendon. The ankle dorsiflexion was 22.6°±3.7° and the plantar flexion 25.3°±3.7°, According to the Arner-Lindholm evaluation, the clinical efficacy was rated as excellent in 25 cases and as good in 1 case, giving an excellent and good rate of 100% (26/26).Conclusion:In the minimally invasive repair of acute closed Achilles tendon rupture, TNST shows the advantages of limited surgical invasion, a low incidence of postoperative complications, and reliable curative effects.

Objective: To investigate the status of insomnia, Internet addiction, and depressive symptoms among medical students and to analyze the effect of Internet addiction on insomnia and the mediating role of depressive symptoms, in order to provide a basis for the development of targeted interventions and measurements for medical students. Methods: A stratified whole group sampling method was used to select full-time college students from three medical universities in Anhui Province. The Chinese version of Insomnia Severity Index (ISI), Internet Addiction Test (IAT) scale and 9-item Patient Health Questionnaire (PHQ-9) were used to evaluate the symptoms of insomnia, Internet addiction and depressive in students. A multivariate Logistic regression analysis was used to explore the factors influencing insomnia among medical students and to analyze the relationship between insomnia with Internet addiction and depressive symptoms, respectively. Results: The overall rate of Internet addiction was 49.5%, depressive symptoms was 39.5%, insomnia was 18.6%. High academic stress, and the presence of surrounding people diagnosed with COVID-19 were associated with a higher risk of insomnia ( P <0.05). The higher the level of Internet addiction (mild, OR =2.60; moderate/severe, OR =4.21) and depression. (mild, OR =6.35; moderate/severe, OR =19.32), the higher the risk of insomnia. Mediated effect analysis showed that Internet addiction had a direct predictive effect ( β =0.02, P <0.05) on insomnia and also indirectly affected insomnia through depression (indirect effect=0.07，95% CI =0.06-0.08). Conclusion The detected rates of insomnia, Internet addiction and depressive symptoms are high among medical students in Anhui Province, and Internet addiction and depressive symptoms are risk factors for insomnia, which should be given more attention and appropriate interventions when necessary to improve their physical and mental health.

Objective To explore the feasibility,safety and efficacy of customized porous tantalum acetabular patch made by three-dimensional (3D) printing technique in treating adult developmental dysplasia of the hip (DDH).Methods Eight adult patients with Crowe Ⅰ type DDH (2 men and 6 women,with a mean age of 43.75±7.81 years,range 33-58 years) who were treated with 3D printed customized porous tantalum acetabular patch hip reconstruction from January 2017 to September 2017 were included.The 3D printing technique was used for reconstructing and designing the optimal acetabular patch for the personalized hip joint of each patient.The acetabular patch was subjected to porous processing and finite element analysis until the biomechanical requirements were met.The 3D printing of porous tantalum acetabular patch and post-processing was subsequently performed.The acetabular patch was implanted through the anterior approach of the hip joint.The operative duration,intraoperative blood loss and complications were recorded.All the included patients were followed up at 1.5,3 and 6 months postoperatively.Pain was assessed using the visual analog scale (VAS),and the hip joint function was evaluated using the Harris score and gait analysis.The patients underwent anterior-posterior radiography and 3D computed tomography of the hip joint aiming to observe the position of the acetabular patch and osteoarthritis progression.Results The mean operative duration was 1.13±0.23 h,and the mean blood loss was 114.17±41.22 ml.All patients were followed up for 6 to 12 months,with an average of 8.2 months.The mean lateral central-edge angle and anterior central-edge angle ranged from 9.83°±5.34° preoperatively to 32.67°±2.53° postoperatively and from 3.83°± 2.79° preoperatively to 21.67°± 1.87° postoperatively,respectively.The rate of acetabular coverage increased from 57.33％±7.97％ preoperatively to 87.33％±4.56％ postoperatively.The VAS and Harris scores ranged from 2.92± 0.79 preoperatively to 0.83±0.72 postoperatively and from 69.67±4.62 preoperatively to 84.25±4.14 postoperatively with statistically significant difference,respectively.The results of gait analysis showed that the step speed,stride,the range of motion of hip and knee were better than that preoperatively.The images suggested a close contact between the tantalum acetabular patch and the iliac bone without loosening and progress of osteoarthritis in hip joint.Conclusion 3D printed customized porous tantalum acetabular patch could reconstruct the defect of acetabular,increase the coverage,and delay the progress of osteoarthritis of the hip joint.This method could reduce the difficulty of hip reconstruction,and the patients could obtain better joint function at the early stage.

Clinical data of 26 patients with proton pump inhibitor dependent gastroesophageal reflux disease (GERD) who underwent anti-reflux mucosectomy (ARMS) in Nanjing Drum Tower Hospital from July 2017 to December 2020 were reviewed, and the GERD questionnaire (GERD-Q) score, the short-form reflux-qual (RQS) score, esophageal motility and 24 h esophageal pH parameters before and after ARMS were compared. With a median follow-up period of 18.4 months (6-27 months), 23 (88.5%) patients reported symptomatic improvement and 15 (57.7%) patients discontinued the use of proton pump inhibitors. After ARMS, the mean scores of GERD-Q (6.23 VS 13.19, P=0.004) and RQS (26.67 VS 10.98, P<0.001) were significantly improved, the mean DeMeester score (10.69 VS 53.15, P<0.001), the mean acid exposure time percentage (3.56% VS 9.92%, P<0.001) and the mean number of acid reflux episodes (36.9 VS 139.9, P=0.001) were lower, and the mean rest pressure at lower esophageal sphincter (LES) (25.19 mmHg VS 13.63 mmHg, P<0.001) and the mean distal contractile integral (1 819.15 mmHg·s·cm VS 1 007.67 mmHg·s·cm, P<0.001) were significantly increased compared with those before surgery. ARMS has significant short-term efficacy in the treatment of proton pump inhibitor dependent GERD, which can effectively improve reflux symptoms and life quality of patients, and strengthen the rest pressure of LES and peristalsis of the esophageal body.

Objective To investigate efficacy and safety of oral prednisone acetate for prevention of esophageal stenosis after endoscopic submucosal dissection ( ESD) for patients with esophageal precancerous lesions or early esophageal carcinoma. Methods A retrospective analysis was performed on data of 56 patients who underwent circumferential or semi-circumferential ( more than three quarters but not a complete circular) ESD for esophageal precancerous lesions or early cancer in Nanjing Drum Tower Hospital from October 2014 to October 2017. The patients were divided into the study group ( n=26, prednisolone oral administration after ESD ) and the control group ( n=30, without prednisolone oral administration after ESD) . Endoscopic dilatation was performed whenever patients experienced persistent dysphagia to solids. Clinical data, stricture rate, numbers of endoscopic dilatation, and adverse events were compared between the two groups. Results There were no differences in age, gender, location and length of lesions, endoscopic findings, depths of tumor invasion, and pathological subtypes between the two groups ( all P>0. 05) . The proportion of circumferential esophageal lesions in the study group was higher than that in the control group[53. 85％ (14/26) VS 23. 33％ (7/30), χ2=5. 53, P=0. 02]. The rata of post-procedural esophageal stricture in the study group was significantly lower than that in the control group[ 30. 77％ ( 8/26) VS 60. 00％ (18/30), χ2=4. 78, P=0. 03], and the number of endoscopic dilatation was lesser in the study group than the control group (3. 85±2. 57 VS 9. 83±5. 82, t =7. 22, P =0. 00). There were no adverse events related to oral prednisone, and no treatment-related mortality. Conclusion Prednisone acetate oral administration is safe and effective to prevent esophageal stenosis after complete or semi-circular ESD for patients with esophageal precancerous lesions or early esophageal carcinoma.

[摘 要] 目的：探讨长基因间非编码RNA 00519（long intergene non-coding RNA 00519，LINC00519）调控miR-876-3p/高迁移率家族蛋白A1（high mobility group protein A1，HMGA1）轴在胃癌HGC-27细胞的增殖、凋亡、迁移和侵袭中的作用。方法：采用qPCR检测胃癌细胞HGC-27和胃黏膜上皮细胞GES-1中LINC00519的表达水平。将HGC-27细胞按转染处理分为si-NC、si-LINC00519、si-LINC00519+anti-miR-NC和si-LINC00519+anti-miR-876-3p组，采用集落形成实验检测细胞克隆形成能力，流式细胞术检测细胞凋亡和周期分布，Transwell实验检测细胞迁移和侵袭。双荧光素酶报告实验和qPCR验证LINC00519与miR-876-3p、miR-876-3p与HMGA1之间的相互作用。结果：HGC-27细胞中LINC00519表达较GES-1细胞显著升高（P<0.05），转染siRNA后si-LINC00519组HGC-27细胞中LINC00519的表达水平较si-NC组显著降低（t=47.294，P<0.01）。与si-NC组比较，si-LINC00519组HGC-27细胞克隆数、迁移侵袭数、S期细胞比例均显著降低（均P<0.01），凋亡率、G0/G1期细胞比例均显著升高（均P<0.01）。与si-LINC00519+anti-miR-NC组比较，si-LINC00519+anti-miR-876-3p组HGC-27细胞克隆数、迁移侵袭数、S期细胞比例升高（均P<0.01），凋亡率、G0/G1期细胞比例显著降低（均P<0.01）。LINC00519能够靶向负调控miR-876-3p的表达，miR-876-3p靶向负调控HMGA1的表达。结论：敲降LINC00519能够通过调控miR-876-3p/HMGA1轴抑制胃癌HGC-27细胞的增殖、迁移和侵袭，诱导细胞凋亡。