Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective:This multicenter retrospective study aimed to analyze the clinicopathological features of duodenal adenocarcinoma (DA) and identify prognostic factors for postoperative survival.Methods:Demographic characteristics, clinicopathological features, treatment outcomes and survival of DA patients undergoing surgical treatment at 18 Chinese medical centers from January 2012 to December 2023 were retrospectively analyzed.Results:Among the 2 056 DA patients included, 46.8% (963) had extra-ampullary DA (EA-DA), and 53.2% (1 093) had peri-ampullary DA (PA-DA). The 1-, 3-, and 5-year overall survival (OS) rates for patients who underwent radical surgery were 93.2%, 71.0%, and 57.2%, respectively. The median overall survival was 76 months, and the median progression-free survival (PFS) was 65 months. No differences in survival were observed between the laparotomy group and minimally invasive surgery (MIS) group either before or after propensity score matching (OS: 76 vs. 75 months before PSM, P=0.986; OS: 75 vs. 75 months after PSM, P=0.602). Furthermore, there were no significant differences between-group in operation time and postoperative complications ( P＞0.05). The MIS group experienced less intraoperative blood loss and shorter hospital stays. The multivariate Cox regression analysis revealed that advanced age ( HR=1.43,95% CI:1.18-1.73), elevated carbohydrate antigen 19-9 levels ( HR=1.24,95% CI:1.02-1.51), perineural invasion ( HR=1.44,95% CI:1.14-1.81), vascular invasion ( HR=1.35,95% CI:1.07-1.71), advanced T stage (T3-4 vs. T1-2: HR=1.86,95% CI:1.49-2.31), regional lymph node metastasis ( HR=1.93,95% CI:1.58-2.36), preoperative biliary drainage ( HR=1.26,95% CI:1.04-1.53), intraoperative blood loss ( HR=1.34,95% CI:1.11-1.62), clinically significant postoperative pancreatic fistulas ( HR=1.53,95% CI:1.12-2.09), and postoperative hemorrhage ( HR=1.62,95% CI:1.14-2.29) were independent risk factors for poor prognosis after surgery (all P＜0.05). Conclusions:Radical surgery is associated with favorable overall survival among DA patients, and no difference in survival is observed between EA-DA and PA-DA patients. MIS is a reliable alternative for DA treatment.

Objective:The purpose of this study was to investigate the clinical value of CT-guided localization of pulmonary nodules with soft wire hook-wire by trailing technique.Methods:The clinical data of 211 pulmonary nodules of 185 patients from November 2020 to March 2022 in Beijing Aerospace General Hospital were retrospectively analyzed. The pulmonary nodules were localized with soft wire hook-wire by trailing technique before video-assisted thoracic surgery (VATS). The success rate, complications, pathological results and localization operations related data were statistically analyzed.Results:The success rate of localization was 97.63% (206/211), and the success rate of VATS removal was 99.53% (210/211). The average operation time was (7.19 ± 2.62) min, and the average time required for resection of lesions was 27 min (10 to 126 min). During the surgery, the soft wire hook-wire of two patient was found to be dislocated and retracted into the chest wall. The pulmonary nodules were successfully located and removed according traces left by puncture points on the lung surface. It was found that the hook-wire was located in the interlobar fissure in 3 patients. The pulmonary nodules were successfully removed by the hook-wire position and appropriately expanding the resection range. A minor pneumothorax occurred in 49 patients, but no closed drainage was needed; 12 patients developed intrapulmonary hematoma; 15 patients with chest pain were treated with analgesia.Conclusions:For small pulmonary nodules requiring thoracoscopic surgery, the computed tomography-guided pulmonary nodule localization with soft wire hook-wire by trailing technique is more convenient, safe and effective, and is worthy of promotion to use.

Objective To investigate the therapeutic effect and prognostic significance of lateral lymph node dissection (LPLND) in patients with lateral lymph node (LPLN) metastasis. Methods The clinicopathological data of rectal cancer patients who underwent total mesorectal excision (TME) combined with LPLND and pathologically confirmed as LPLN metastasis after operation were retrospectively analyzed. The clinicopathological characteristics and metastasis rules of patients with LPLN metastasis were discussed, and the survival prognosis after LPLND was analyzed. Results A total of 102 rectal cancer patients with pathologically confirmed LPLN metastasis were included. The common sites of LPLN metastasis were internal iliac vessels lymph nodes (n=68, 66.7%), followed by obturator lymph nodes (n=44, 43.1%), and common iliac vessels or external iliac vessels lymph nodes (n=12, 11.8%). There were 10 patients (9.8%) with bilateral LPLN metastases, and the mean number of LPLN metastases was 2.2±2.4, among which 16 patients (15.7%) had LPLN metastases number≥2. The 3-year OS (66.8% vs. 7.7%, P < 0.001) and DFS (39.1% vs. 10.5%, P=0.012) of patients with LPLN metastases to the external iliac or common iliac lymph node were significantly lower than those with metastases to the internal iliac or obturator lymph node. The multivariate analysis showed that LPLN metastasis to external iliac or common iliac lymph node was an independent risk factor both for OS (HR=3.53; 95%CI: 1.50-8.31; P=0.004) and DFS (HR=2.40; 95%CI: 1.05-5.47; P=0.037). Conclusion LPLN mainly metastasizes to the internal iliac or obturator lymph node areas. The survival of patients with metastasis to the external iliac or common iliac lymph node cannot be improved by LPLND, and thus systemic comprehensive treatment is often the optimal treatment option.

In atherosclerosis, chronic inflammatory processes in local diseased areas may lead to the accumulation of reactive oxygen species (ROS). In this study, we devised a highly sensitive H₂O₂-scavenging nano-bionic system loaded with probucol (RPP-PU), to treat atherosclerosis more effectively. The RPP material had high sensitivity to H₂O₂, and the response sensitivity could be reduced from 40 to 10 μmol/L which was close to the lowest concentration of H₂O₂ levels of the pathological environment. RPP-PU delayed the release and prolonged the duration of PU in vivo. In Apolipoprotein E deficient (ApoE^‒/‒) mice, RPP-PU effectively eliminated pathological ROS, reduced the level of lipids and related metabolic enzymes, and significantly decreased the area of vascular plaques and fibers. Our study demonstrated that the H₂O₂-scavenging nano-bionic system could scavenge the abundant ROS in the atherosclerosis lesion, thereby reducing the oxidative stress for treating atherosclerosis and thus achieve the therapeutic goals with atherosclerosis more desirably.

Objective To investigate the effect of the amputation order of pulmonary artery and pulmonary artery on pulmonary residual blood volume in total thoracoscopic lobectomy.Methods Sixtyeight patients who were scheduled to underwent total thoracoscopic lobectomy from June 2015 to April 2019 in Beijing Aerospace General Hospital were selected.The patients were divided into first amputation pulmonary artery group and first amputation pulmonary vein group by random envelope method with 34 cases in each group.Five cases in first amputation pulmonary artery group and 4 cases in first amputation pulmonary vein group were excluded because of the procedure modification or the fragmentation of the specimen during the course of operation.In the end,29 cases were enrolled in first amputation pulmonary artery group and 30 cases in first amputation pulmonary vein group.In first amputation pulmonary vein group,all arteries were ligated before interruption of the veins;and in first amputation pulmonary artery group had a reverse sequence.The perioperative period status were recorded,and the crude pulmonary quality,dry pulmonary quality,pulmonary residual blood volume and adjusted pulmonary residual blood ratio were measured or calculated.Results All 59 patients were operated successfully.No serious complications occurred,no perioperative death occurred,and no patients needed blood transfusion.There was no statistical difference in the incidence of minor complications between first amputation pulmonary artery group and first amputation pulmonary vein group:27.6％ (8/29) vs.33.3％ (10/30),P＞0.05.There were no statistical differences in operative time,transoperative bleeding volume,pulmonary residual blood volume,crude pulmonary quality,dry pulmonary quality,adjusted pulmonary residual blood ratio,hemoglobin difference before and after surgery,postoperative drainage time and postoperative hospitalization time between 2 groups (P＞0.05).Conclusions The amputation order of pulmonary artery and pulmonary vein sequence of vessel interruption during total thoracoscopic lobectomy has no effect on the pulmonary residual blood volume,can be reasonably selected according to the intraoperative situation.

Objective To observe the effects of Tongluo-Jiedu-Huazhuo decoction on hemorheological indexes and gastric juice components in patients with chronic atrophic gastritis.Methods According to the inclusion criteria,84 patients with chronic atrophic gastritis were randomly divided into the observation group and the control group,with 42 cases in each group.The control group received the routine clinical treatment,and the observation group was treated with Tongluo-Jiedu-Huazhuo decoction on the basis of the control group.The clinical symptoms were scored before and after treatment.The blood viscosity,plasma viscosity,hematocrit,fibrinogen and erythrocyte aggregation index were measured bY automatic hemorheology instrument,and gastric juice pH,free acid,pepsin and nitrite levels were measured by serial gastric juice detection method.The clinical efficacy was evaluted.Results The total effective rate of the observation group was 90.5％ (38/42),and the total effective rate of the control group was 76.2％ (32/42),with statistically significant difference (Z=-2.683,P＜0.05).After treatment,the scores of epigastric pain,stomach swelling,nausea and vomiting,acid reflux and dietary deficiency in the observation group were significantly lower than those in the control group (t were 4.865,4.632,4.716,4.582,4.433,respectively,all Ps＜0.05),and the whole blood viscosity,plasma viscosity,hematocrit,fibrinogen and erythrocyte aggregation index were significantly lower than those in the control group (t were 5.044,4.462,5.274,4.231 and 4.485,respectively,all Ps＜0.05).The gastric juice pH (2.28 ± 0.33 vs.2.75 ± 0.38,t=4.825),nitrite (33.27 ± 4.45 mg/L vs.38.80 ± 4.93 mg/L,t=5.136) in the observation group were significantly lower than the control group (P＜0.05).The free acid (22.13 ± 3.36 mmol/L vs.18.65 ± 2.54 mmol/L,t=5.382),pepsin (144.56 ± 15.86 U vs.137.16 ± 14.63 U,t=5.736) in the observation group were significantly higher than the control group (P＜0.05).Conclusions The application of Tongluo-Jiedu-Huazhuo decoction in patients with chronic atrophic gastritis can improve the hemorrheology index and regulate the function of gastric secretion,which is helpful to protect the gastric mucosa and relieve the clinical symptoms.

Objective: To investigate the clinical efficacy of reduced port laparoscopic radical resection on colorectal cancer. Methods: Clinical data of 46 patients with colorectal cancer undergoing reduced port laparoscopic radical resection were retrospectively analyzed. Results: All of 46 patients underwent laparoscopic surgery, with an average operation time of 206 minutes, an average intraoperative bleeding of 56 ml, an average number of lymph nodes removement of 12/case (ranged from 6 to 21). One case had incision infection, 2 cases had anastomotic leakage, and they all recovered and discharged after treatment. Conclusions Reduced port laparoscopic radical resection of colorectal cancer is safe and feasible, reduces labor costs, and has a good clinical efficacy, which is worthy of clinical promotion.

BACKGROUND: Preoperative computed tomography (CT) guided microcoil localization is a common method for small lung nodules before video-assisted thoracoscopic surgery (VATS). However, this method still has some limitation such as complicated operation and slight complications. We have optimized the original method. The purpose of this study was to investigate the clinical value of this optimized method. METHODS: 35 pulmonary nodules from 31 patients between September 2018 and January 2019 were localized by the optimized method before VATS. The success rate, complications, pathological results and localization operations related data were statistically analyzed. RESULTS: The success rate of localization was 97.1%, and the success rate of VATS removal was 100%. The average operation time was 10.1 min (5 min-31 min), and the average time required for resection of lesions was 38.2 min (10 min-100 min). During the surgery, the microcoil of one patient was found to be dislocated and retracted into the chest wall. A puncture needle was inserted intolung tissue from the chest wall puncture point after the lung was inflated, and then the pulmonary nodule were successfully located and removed. A minor pneumothorax occurred in 3 patients, but no closed drainage was needed. Three patients developed intrapulmonary hematoma. The pathological results of 35 pulmonary nodules included 15 well-differentiated adenocarcinoma, 7 carcinoma in situ, 5 microinvasive adenocarcinoma, 4 atypical adenomatoid hyperplasia, 2 intrapulmonary lymph node hyperplasia, 2 inflammatory nodules. CONCLUSIONS For small pulmonary nodules requiring thoracoscopic surgery, the optimized computed tomography-guided pulmonary nodule microcoil localization technique is convenient, safe and effective, and worthy of promotion to use.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; surgery ; Lymph Nodes ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Multiple Pulmonary Nodules ; diagnostic imaging ; surgery ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed ; Young Adult

Objective To assess the choice between direct operation and followed- up observation for subclinical esophageal submucosal mass. Methods The clinical data of 133 patients with subclinical esophageal submucosal mass from February 1996 to October 2013 were retrospectively analyzed. The patients were divided into 2 groups according to the modes of intervention: direct operation group (82 cases) and followed-up group (51 cases). Their clinical data, imaging, endoscopy information, modes of intervention and final outcome were compared. Results All of the 133 patients were considered as esophageal leiomyoma. The age and body examination detection rate in direct operation group were significantly lower than those in followed-up group: (47.7 ± 13.1) years vs. (52.2 ± 10.1) years and 15.9% (13/82) vs. 37.3% (19/51), the tumor diameter, case history and incidence of chest and abdominal pain were significantly higher than those in followed-up group: (2.2 ± 1.4) cm vs. (1.7 ± 1.0) cm, 51 (44, 60) months vs. 47 (40, 55) months and 28.0% (23/82) vs. 9.8% (5/51), and there were statistical differences (P＜0.05 or ＜0.01). There was no operative mortality in direct operation group, and the incidence of mild surgical complication was 8.5% (7/82); the pathological result showed that esophageal leiomyoma and other benign diseases were in 70 cases, and malignant disease in 12 cases (12 cases of malignant diseases who missed diagnosis before operation were mostly caused by incomplete examination.). In followed-up group, the mean observation time was 35.5 (3 to 240) months, disease progression was in 23 cases (45.1%, 23/51), 3 cases developed new-onset symptoms, 20 cases increased in diameter, and the average doubling time was 856 (126 to 2 891) d. Twenty-seven patients eventually underwent surgery (52.9%, 27/51, post-observation intervention group), without perioperative death, and the incidence of surgical complication was 7.4% (2/27). The pathological result showed that esophageal leiomyoma and other benign diseases were in 23 cases, and malignant disease in 4 cases. Compared with direct operation group, post-observation intervention group had no delayed treatment due to the observation and did not increase the surgery risk and difficulty, and no malignant transformation occurred. Conclusions Subclinical esophageal submucosal mass could be followed up, but endoscopic ultrasonography, CT and gastrointestinal angiography must be performed and must be followed up closely.