Objective To review the research advancement of multimodal therapy for advanced gastric carcinoma.Methods The literatures on multimodal therapy for advanced gastric carcinoma in recent years were collected and reviewed.Results The multimodal therapy,such as preoperative chemotherapy,preoperative adjuvant chemoradiotherapy,preoperative interventional chemoradiotherapy for advanced gastric carcinoma was effective because it could increase the rate of R0 resection for the patients with advanced gastric carcinoma.And it can decrease the mortality rate after operation,extend the overall survival time and improve patients' life quality.Conclusion Multimodal therapy is a promising method for the treatment of advanced gastric carcinoma and it should be further developed.

Objective To explore the clinical value of combined detection of serum CD4 + T cells and CD8 + T cells for advanced gastric cancer (AGC).Methods Serum levels of CI4 + T cells and CD8 + T cells were measured by flow cytometry and compared in 20 patients with AGC (experimental group) and 20 healthy adults (control group).Also,serum levels of CD4 + T cells and CD8 + T cells were measured by flow cytometry and compared before and after surgical treatment in the patients of experimental group.Results The serum levels of CD4 + T cells were decreased and CD8 + T cells were increased in patients with AGC.However,the serum levels of CD4 +T cells were increased and CD8 +T cells were decreased after surgical treatment (P ＜ 0.05).Conclusions The serum levels of CD4 + T cells and CD8 + T cell help to assess the immune status of patients with AGC,which contributes to the illness monitoring for AGC.

Objective To explore the expression and distribution characteristics of 5-hydroxytryptamine receptor 2B (5-HT2BR) in tumor tissue,blood and gastric juice of patients with gastric cancer.Methods From 2006 to 2013 gastric cancer tissue paraffin specimens were collectec from 30 stomach cancer patients,gastric ulcer paraffin specimens from 10 patients,and gastric juice,blood samples and fresh tumor tissues were collected from gastric cancer patients undergoing surgery.Corresponding samples were collected in 15 cases of chronic superficial gastritis while receiving gastroscopy.By using ELISA and PV-9000 immunohistochemistry 5-HT2BR expression was determined.Results There was no positive expression of 5-HT2BR in benign gastric tissues (n =15).The positive expression rate of 5-HT2BR between gastric cancer and gastric benign lesions has significant difference (P＜0.01).Integral optical density value and positive area of 5-HT2BR in low differentiation tissues of gastric cancer were higher than high and medium differentiation tissues of gastric cancer (P ＜ 0.01).There was no statistically significant difference among 5 HT2BR and constituent ratio of patients at tumor stage,differentiated degree,histological type,infiltration depth and lymph node metastasis (all P ＞ 0.05).The differences of 5-HT2BR expression in gastric juice and blood between gastric cancer patients and chronic gastritis patients are statistically significant(P ＜ 0.01).Conclusions 5-HT2BR are highly expressioned in blood,gastric juice and tumor tissues of patients with gastric cancer in a differentiation related manner.

Objective To summarize the current value of neoadjuvant chemotherapy(NAC) for potentially resectable gastric cancer.Methods The recent 5-year literatures searched through the PubMed with the key words:stomach neoplasm,gastric cancer/carcinoma,neoadjuvant therapy/chemotherapy and preoperative therapy/chemotherapy as well as the relevant reports presented in the ASCO Annual Meeting in 2007 and 2008 were analyzed.The present status of NAC for advanced gastric cancer was summarized,the necessity and feasibility were evaluated,and the patients features for selecting,the predictors for response,the mainly existing problems and development trend of NAC were analyzed.Results At present,there were 7 randomized control trails(RCT) published,and among them 3 were phase Ⅲ.It was safe,effective and feasible to most of trails in NAC for gastric cancer.However,it was still little to obtain survival benefit for NAC RCT,and short of randomized trial comparing strict preoperative chemotherapy to surgery alone or perioperative chemotherapy to surgery plus adjuvant chemotherapy.It remained lots of problems such as how to select the appropriate patients,the effective induced regimes and the predicted factors,the evaluated indices for response.Conclusion NAC is a safe,feasible and efficient method to potentially resectable gastric cancer,but strict phase Ⅲ randomized trials are needed.In the future,substantial improvements of treatment outcome will likely depend on the novel drugs and molecular biological targeted therapies.

Objective To explore the clinical value of gastric bare area (GBA) for the prognosis of gastric fundus and cardia carcinoma.Methods The data of 82 patients with gastric fundus and cardia carcinoma from January 2010 to December 2011 were retrospectively analyzed.The patients were divided into group A (49 cases) with cancer cell invasion in GBA and group B (33 cases) without invasion in GBA.All the patients underwent D2 gastrectomy plus surgical resection of GBA and were treated by 6 cycles of postoperative FOLFOX-4 chemotherapy scheme.Postoperative follow-up and survival analysis were carried out for patients in both groups.Results According to survival analysis (Kaplan-Meier method),the postoperative 1-,2-and 3-year cumulative survival rates of the patients in group A were 91.8 ％,57.3 ％ and 29.0 ％,respectively,while those of the patients in group B were 93.9 ％,75.0 ％ and 48.2 ％,respectively.The median survival times of the patients in group A and group B were 27.0 months and 36.0 months,respectively,which was demonstrated existing statistical significance(X2 =4.972,P =0.026).Conclusions The prognosis of gastric fundus and cardia carcinoma patients with invasion in GBA by cancer cells is poor.Surgical resection of GBA may help to improve the prognosis of the patients with gastric fundus and cardia carcinoma.

Objective To explore the clinical value of combined detection of serum carbohydrate antigen 724 (CA724),carcinoembryonic antigen (CEA),and tumor necrosis factor-α (TNF-α) for the diagnosis,assessment of curative effect,and illness monitoring for advanced gastric cancer (AGC).Methods Serum levels of CA724,CEA and TNF-α were measured by the methods of chemiluminescence and compared in 20 patients with AGC (Group A),20 patients with benign gastric disease (Group B),and 20 healthy adults (Group C).Also,serum levels of CA724,CEA and TNF-α in peripheral blood as well as in portal vein were measured and compared before and after surgical treatment in patients of group A.Results The serum levels of CA724,CEA and TNF-α in patients of group A were significantly higher than groups B and C (P ＜ 0.05).In addition,the serum levels of CA724,CEA and TNF-α in patients of group A were decreased after surgical treatment and increased slightly after one month (P ＜ 0.05).Conclusions The serum levels of CA724,CEA and TNF-α in most patients of AGC are significantly elevated and the combined detection of serum CA724,CEA and TNF-α contributes to the diagnosis,assessment of curative effect,and illness monitoring for AGC.

Objective To investigate the clinical significance of lymphatic mapping and sentinel lymph nodes (SLNs) biopsy in the diagnosis and treatment of gastric cancer. Methods A retrospective analysis was carried out based on the data of 46 patients who had received D2 gastrectomy from January 2003 to June 2006. The SLNs stained by methylene blue were resected for biopsy. Results The success rate of SLNs biopsy was 83% (38/46). The sensitivity, false-negative rate, accuracy, specificity, negative predictive value and positive predic-tive value of SLNs were 69% (18/26), 31% (8/26), 79% (30/38), 100% (12/12), 60% (12/20) and 100% (12/12). The sensitivity, accuracy and negative predictive value were 100% in patients with tumor in pT1 stage or TNM I stage, or with the diameters of the tumors under 4 era. The tumor site, and the degree of lymph node metastasis affected the success rate of biopsy, and the invasion depth, clinical stage and the degree of lymph node metastasis affected the sensitivity, accuracy and negative predictive value of biopsy. Conclusions The application of sentinel lymph node biopsy using methylene blue in gastrie cancer is feasible. The sensitivity, accuracy and reliability are high in patients at early stage of gastric cancer.

Objective To explore the clinical value of intraoperative interorganizational targeted injection chemotherapy (IITIC) in Dixon operation of advanced rectal cancer (ARC).Methods From June 2013 to December 2013,53 patients who suffered from ARC and were treated by operation in our hospital were divided into group A and group B randomly.29 patients in group A were carried out Dixon operation and IITIC,while 24 patients in group B were carried out Dixon operation only.Serum levels of tumor necrosis factoroα (TNF-ot),carcinoembryonic antigen (CEA) and carbohydrate antigen 242 (CA242) were measured and compared for all the patients in perioperative period.Also,Serum levels of white blood cell (WBC),platelet (PLT),alanine aminotransferase (ALT),aspartate aminotransferase (AST) and creatinine (Cr) were measured and compared for all the patients in perioperative period.Postoperative anastomotic fistula,intra-abdominal hemorrhage,intra-abdominal abscess and death were observed and compared between group A and group B.Postoperative follow-up and survival analysis were carried out for patients in both groups.Results The serum levels of TNF-α,CEA and CA242 at each time point were significantly different both in group A and group B (P ＜ 0.05).Furthermore,The serum levels of TNF-α and CA242 were statistically different between group A and group B (P ＜ 0.05),while there was no statistically significant difference in the serum levels of CEA (P ＞ 0.05).The serum levels of WBC,ALT,AST and Cr were not statistically significant difference between group A and group B (P ＞ 0.05),while the serum levels of PLT were statistically significant difference (P ＜ 0.05).All of the 53 patients were not encountered anastomotic fistula,intra-abdominal hemorrhage,intra-abdominal abscess and death.According to survival analysis,the postoperative1-,2-and 3-year cumulative survival rates of the patients in group A were 93.1％,85.9％ and 71.1％,respectively,while those of the patients in group B were 91.5％,78.4％ and 61.0％,respectively.The median survival times of the Patients in group A and group B were 40.0 months and 39.0 months,respectively,the difference was not statistical significant (P ＞ 0.05).Conclusions It is safe and feasible to carry out IITIC in Dixon operation for ARC.IITIC can increase the treatment effect to operation of ARC,which also can improve patients' prognosis.

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
Humans ; China/epidemiology* ; Cross Infection/epidemiology* ; Intensive Care Units/statistics & numerical data* ; Quality Control ; Quality Indicators, Health Care/statistics & numerical data* ; Sepsis/therapy* ; East Asian People/statistics & numerical data*