Objective To evaluate systematically the long-term efficacy and prognostic factors of surgical treatment for gastric carcinoma with liver metastases (GCLM).Methods Database including Chinese Journal Full Text Database,Wan Fang Database,VIP database,Chinese Database of Literature on Biomedicine,Pubmed,EMBASE,Cochrane Library,Medline,Springerlink and Wiley Online Library were searched with“胃癌,胃月中瘤,肝转移,手术治疗,外科手术,肝切除术,生存率,预后因素,gastric cancer,gastric carcinoma,hepatic,resection,hepatic resection,hepatectomy,liver metastases,hepatic metastases,surgery,surgical,survival,prognostic factors.The time for retrieving was from January 1995 to August 2015.Literatures on longterm efficacy and prognostic factors of radical resection of gastric carcinoma combined with hepatectomy for GCLM were retrieved,and data were analyzed and evaluated by 2 independent researchers.The count data were presented by the relative risk (RR) and 95％ confidence interval (95％ CI).The group rate was merged by the formula RR/(1 + RR),corresponding 95％ CI upper limit values were transferred by the formula RR/(1 + upper limit value RR),and the lower limit values were transferred by the formula RR/(1 + lower limit value RR).The comparison of group rates was done by indirect comparison,Z =difference between group rate/√∑ni=1 (standard error of group rate)2.The heterogeneity was analyzed by I2.Results Eighteen literatures of cross-sectional studies were retrieved and the total sample size was 410 patients.The results of Meta analysis:(1) the summary RR of 3-year overall survival of surgical patients with GCLM was 0.47 (95％ CI:0.37-0.60) while the summary 3-year overall survival rate was 32.0％ (95 ％ CI:0.27-0.38).(2) The summary RR of 5-year overall survival of surgical patients with GCLM was 0.35 (95％ CI:0.27-0.45),summary RR of 5-year overall survival rate was 25.9％ (95％ CI:0.21-0.31).(3)The summary RR of overall recurrence of surgical patients with GCLM was 2.95 (95％CI:2.23-3.88) while the summary overall recurrence rate was 74.7％ (95％CI:0.69-0.80).(4)The summary RR of remnant liver recurrence of surgical patients with GCLM was 1.39 (95％ CI:0.91-2.15) while the summary RR of remnant liver recurrence rate was 58.2％ (95％ CI:0.48-0.68).(5)The summary 3-year survival rate of surgical patients with GCLM and primary carcinoma serosal invasion was 32.9％ (95％ CI:0.23-0.44),and summary 5-year survival rate was 25.9％ (95％ CI:0.16-0.40).The summary 3-year survival rate of surgical patients with GCLM and without primary carcinoma serosal invasion was 47.9％ (95％ CI:0.38-0.58),and summary 5-year survival rate was 38.3％ (95％ CI:0.29-0.49).The summary 3-year survival rate of surgical patients with synchronous hepatic metastases was 30.6％ (95 ％ CI:0.24-0.38),and summary 5-year survival rate was 24.2％ (95％ CI:0.18-0.32).The summary 3-year survival rate of surgical patients with metachronous hepatic metastases was 40.1％ (95％ CI:0.32 0.48),and summary 5-year survival rate was 32.9％ (95％ CI:0.25-0.41).The summary 3-year survival rate of surgical patients with solitary metastatic hepatic carcinoma was 47.6％ (95％ CI:0.40-0.56),and summary 5-year survival rate was 37.1％ (95 ％ CI:0.26-0.48).The summary 3-year survival rate of surgical patients with multiple metastatic hepatic carcinoma was 28.6％ (95％ CI:0.18-0.42),and summary 5-year survival rate was 15.3％ (95％ CI:0.07-0.30).The summary 3-year survival rate of surgical patients with GCLM and R0 resection was 28.6％ (95 ％ CI:0.19-0.40),and summary 5-year survival rate was 20.0％ (95％ CI:0.12-0.32).The summary 3-year survival rate of surgical patients with GCLM and without R0 resection was 0.0,and summary 5-year survival rate was 9.1％ (95 ％ CI:0.03-0.25).The summary 3-year survival rate of surgical patients with GCLM and resection margin ＜ 10 mm was 13.0％ (95 ％ CI:0.05-0.30),and summary 5-year survival rate was 8.3 ％ (95 ％ CI:0.02-0.28).The summary 3-year survival rate of surgical patients with GCLM and resection margin ≥ 10 mm was 34.6％ (95 ％ CI:0.21-0.52),and summary 5-year survival rate was 34.6％ (95％ CI:0.21-0.52).The summary 3-year survival rate of surgical patients with GCLM and chemotherapy was 45.9％ (95％ CI:0.29-0.64),and summary 5-year survival rate was 29.1％ (95 ％ CI:0.19-0.42).The summary 3-year survival rate of surgical patients with GCLM and without chemotherapy was 38.7％ (95 ％ CI:0.26-0.53),and the summary 5-year survival rate was 25.4％ (95％ CI:0.18-0.35).The 3-year survival rate of surgical patients without primary carcinoma serosal invasion and with metachronous hepatic metastases,solitary metastatic hepatic carcinoma,R0 resection and resection margin ≥10 mm was statistically significantly higher than that of surgical patients with primary carcinoma serosal invasion,synchronous hepatic metastases,multiple metastatic hepatic carcinoma and resection margin ＜ 10 mm and without R0 resection (Z =2.118,1.999,3.01 8,5.295,2.183,P ＜ 0.05).The 5-year survival rate of surgical patients with solitary metastatic hepatic carcinoma and resection margin ≥ 10 mm was statistically significantly higher than that of surgical patients with multiple metastatic hepatic carcinoma and resection margin ＜ 10 mm (Z =4.528,2.819,P ＜ 0.05).Conclusion Overall long-term efficacy of surgical patients with GCLM is not good enough,and there is the better prognosis in the surgical patients without primary carcinoma serosal invasion and with metachronous hepatic metastases,solitary metastatic hepatic carcinoma,R0 resection and resection margin≥ 10 mm.

OBJECTIVE To study the influence of focused ultrasound on the morphology of nasal mucosa in sheep. METHODS A model CZB ultrasound therapeutic system for rhinitis, developed and produced by Chongqing Haifu(HIFU)Technology Co.,Ltd.,Chongqing China,was used in this study. Linear scans were performed on bovine liver in vitro under different scan parameters, and the biologic focal field(BFF)was detected to evaluate if it met the requirements of designed. The nasal mucosa of inferior turbinate of sheep was exposed with the same scan parameters under the observation of nasal endoscope, and morphological changes of the nasal mucosa were observed by gross examination, light and electron microscopes. RESULTS This study revealed that the designed biological focal field in bovine liver in vitro could be obtained under the scan parameters mentioned above. Linear scan with the same condition,there was no obvious change in appearance and color of the treated nasal mucosa in the inferior turbinate of the sheep. However,3 days after treatment,there was an increased secretion in the nasal cavity,which recovered 7 days post-treatment. Light microscopic examination 3 days after exposure showed that the epithelia of the nasal mucosa was intact and there was diffused distribution of spot coagulated necroses in the subepithelia layer of treated nasal mucosa. Degeneration of vascular endothelial cells and thrombosis of blood vessels were found in the coagulated necrosis region. Besides,degeneration or necrosis of nerve cells was induced,and glandular cells werepartially or completely damaged. The structure of epithelial goblet cells and ciliated cells in the treated nasal mucosa appeared to be normal under the observation of electronic microscope. At the seventh day after treatment,signs of tissue regeneration such as hyperplasia of collagen fiber were found in the coagulated region,and the necrosis tissue began to dissolve and was absorbed at the 14th day post-treatment. CONCLUSION Under the above scan parameters,the energy of focused ultrasound could be deposited specifically at the subepithelia layer,and to ablate the targeted nasal mucous tissues which are rich in blood vessels,nerves and glands. There were no damage to the non-target area such as epithelial layer,which could maintain the normal structure and biological function of mucociliary of nasal mucosa.

Objective:To evaluate the application efficacy of enhanced recovery after surgery(ERAS)in laparoscopic colorectal cancer surgery in primary hospitals.Methods:A total of 116 patients who underwent laparoscopic colorectal cancer surgery from January 2017 to December 2018 at our hospital were enrolled in this study.According to the perioperative rehabilitation program, 116 patients were divided into the group A(n=67, receiving enhanced recovery after surgery)and the group B(n=49, receiving traditional recovery after surgery).Results:The incidences of preoperative thirst and hunger were lower in the group A than in the group B(11.9% vs.53.1%, 16.4% vs.51.0%, χ2=23.10 and 15.83, respectively, P<0.001). The levels of CRP and blood glucose in the two groups were significantly higher after operation than before operation, and reached the peak values on the 3rd day after the operation.At different time points after operation, CRP levels and blood glucose levels were higher in the group B than in the group A(all P<0.05). On the 7th day after operation, blood glucose level was recovered to the preoperative level in the group A, while it was not so in the group B. The incidence of complication in the group A was similar to the group B(7.46% vs.12.2%, χ2=0.75, P>0.05). The hospitalization period was shorter and the hospitalization cost was less in the group A than in the group B(8.16±1.33)d vs.(15.39±2.81)d, (46100±1800)yuan vs.(56900±5600)yuan, t=10.98 and 9.96, P=0.000). Conclusions:The application of enhanced recovery after surgery is beneficial for perioperative safety, can reduce surgical stress response, promote postoperative recovery, shorten hospitalization time after surgery and reduce hospitalization costs in laparoscopic colorectal cancer surgery.

Objective:To analyze the epidemiological and clinical characteristics of patients with brucellosis.Methods:Medical records of confirmed brucellosis patients ( n = 101) were collected from January 2015 to December 2022 at the First Affiliated Hospital of Nanjing Medical University. Patients were divided into acute phase group (≤3 months, n = 89) and non acute phase group (> 3 months, n = 12) according to the course of the disease. The epidemiological characteristics, clinical symptoms, laboratory indicators, treatment plan and curative effect of the patients were analyzed retrospectively. Results:Data of a total of 101 cases of brucellosis were collected, including 72 males and 29 females. The disease occurred throughout the year, with summer (June to August) being the peak period (43.56%, 44/101); 72.28% (73/101) cases had a clear history of contact with animal. Ninety-two point zero eight percent (93/101) of the patients visited the Department of Infectious Diseases for the first time. Clinical manifestations included fever, accounting for 82.18% (83/101), chills accounting for 36.63% (37/101), backache accounting for 33.66% (34/101), night sweats accounting for 22.77% (23/101), and arthralgia accounting for 20.79% (21/101). The symptoms of backache (75.00%, 9/12) and arthralgia (41.67%, 5/12) were more common in patients in the non acute phase group than those of the acute phase group [28.09% (25/89), 17.98% (16/89), P < 0.05]. The most common laboratory test abnormal items were elevated C-reactive protein (CRP, 68.32%, 69/101), erythrocyte sedimentation rate (ESR, 61.39%, 62/101), aspartate aminotransferase (AST, 58.42%, 59/101), and alanine aminotransferase (ALT, 48.51%, 49/101). Elevated ESR (66.29%, 59/89) was more common in patients in the acute phase group than that of the non acute phase group [25.00 (3/12), χ 2 = 7.48, P = 0.006]. All patients were treated with a combination therapy, with a recovery rate of 100.00% (101/101). Conclusions:Brucellosis patients are more common in males, with a higher incidence in summer and often accompanied by a history of contact with animal. The clinical manifestations are diverse and non-specific.