Objective To evaluate laparoscopic radical resection of metachronous colorectal carcinoma.Methods A total of 13 patients with metachronous colorectal carcinoma undergoing laparoscopic resection in Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2013 to December 2015 were analyzed retrospectively.Results The mean time of surgery was (156 ± 9) min.Tumors were located in the right hemicolon in 3 cases,in the transverse colon in one,in the left hemicolon in 2,in the sigmoid colon in four and in the rectum in 4.The mean blood loss was (66 ± 21) ml.There was no conversion to open surgery.Two patients were done with protective ileostomy.Postoperative gastrointestinal function recovery time was (2.5 ± 0.7) days.One postoperative intra-abdominal bleeding was successfully controlled laparoscopically.Posteperative length of hospital stay was (26.2 ± 2.9) days.The median follow-up was 12 months (5-30 months) with no cancer recurrence.Conclusions Laparoscopic radical resection of metachronous colorectal carcinoma has good curative effect,and high success rate in spite of previous history of laparotomy.

The development of behavioral medicine is a new and efficient way to improve the level of national health and the behavior intervention is the core content.There are three methods including story-tellingmethod,behavior-image method and patient-centered assessment and counseling for exercise and nutri-tion intervention(PACE)which have been proven to be effective.The psychological theory of homophily,self-regulation and problem solving provide a scientific explanation for the effectiveness of these three kinds of be-havior intervention.Ripple effect amplifies the effect of behavioral intervention and its psychological mecha-nism is self-determinism and self-regulation theory.In the future,the research of behavior intervention and its psychological mechanism needs to make new breakthroughs in aspects of theory,method and technology.

Objective:To explore the differences of attention bias performance between patients with heroin dependence in methadone maintenance treatment(MMT) and healthy controls.Methods:A total of 38 heroin dependent patients in the Fourth People's Hospital of Huainan from January 2018 to September 2018 were selected as MMTgroup, and 32 gender-and age-matched healthy controls were selected as healthy control(HC) group.The attention bias was evaluated by Emotional Stroop Task, and the difference between the two groups was compared.Results:The error number of the herion-related words in Emotional Stroop Task of MMT group was lower than that of HC group[0.75(2, 5) vs.1(0, 2)], the difference was statistically significant( Z=-2.184, P=0.029). The number of errors in point and neutral words and reaction time of point, neutral word and clue word had no statistically significant differences between MMT group and HC group[1(0, 4) vs.1(0, 2); 3(2, 5) vs.2(2, 3); (1 055.14±303.50)ms vs.(985.40±173.71)ms, (1 126.89±347.82)ms vs.(1 022.76± 173.62)ms; (1 188.53±371.80)ms vs.(1 113.23±225.11)ms]( Z=-1.331, P=0.183; Z=-1.723, P=0.085; t=1.150, P=0.254; t=1.539, P=0.129; t=1.001, P=0.320). There were no statistically significant differences in attention bias influenced by the dosage and duration of methadone between MMT group and HC group(all P>0.05). Conclusion:These results demonstrate that heroin dependence patients in MMT have attentional bias in heroin-related words.Methadone has no effect on attention bias in patients with heroin dependence during maintenance treatment intervention.

Objective To investigate the clinical characteristics,diagnosis and treatment as well as prognostic factors of high-risk gastrointestinal stromal tumors (GIST).Methods Clinical data of 307 patients with high risk GIST treated in the Union Hospital from Jan 2005 to Dec 2016 were retrospectively analyzed.Results There were 172 males and 135 females with median age of 51 (20-84) years.Tumors located in the stomach in 88 (28.7％) cases,in the small intestine in 141 (45.9％),in the colon and rectum in 27 (8.8％) and outside the gastrointestinal tract (mesentery,retroperitoneum,abdominal cavity,and pelvic) in 51 (16.6％).All underwent surgical resection,including R0 resection of 299 cases (97.4％),R1 resection of 6 cases (2.0％) and R2 resection of 2 case (0.7％).68 cases (22.1％) received postoperative imatinib 400 mg/d for 3 to 84 months.The 1-,3-,5-year overall survival rates of high-risk GIST were 95％,86％,76％,the 1-,3-,5-year recurrence-free survival rates were 92％,83％,71％.By multivariate analysis the 5-year RFS were related only to mitotic count while,there was no significant difference in the RFS in patients gender,tumor site,tumor size.Conclusions Complete surgical excision is the effective treatment for high-risk GIST.Mitotic count is the most important prognostic factor.

Objective:To explore the clinical application and curative effect of brachytherapy of denture applicators with 125I seeds in the treatment of palatal malignant tumor. Methods:Thirty patients with palatal malignant tumor who underwent surgical resection in Shandong Provincial Hospital from February 2012 to January 2020, and brachytherapy was performed with applicator additional 125I seeds 2 weeks after surgery. All patients were followed up for treatment effect and adverse reactions. Results:All patients wore 125I seeds denture base denture applicator well, no 125I seeds displacement and loss. 30 patients had 10-60 months of follow-up, among which 1 patient received palliative treatment with 125I seeds denture applicator alone died after 10 months of follow-up; 1 patient with adenoid cystic carcinoma recurred after 2 years of follow-up and underwent surgical treatment again; the rest patients did not see tumor recurrence or metastasis. The side effects, pronunciation and chewing function were improved in patients ( P<0.05). Conclusions:For patients with palatal malignant tumor, postoperative 125I seeds denture applicator can effectively prevent tumor recurrence and metastasis, reduce complications, and improve the quality of life.

Objective: To investigate the morbidity and treatment of early postoperative complications after laparoscopic D2 radical gastrectomy for gastric cancer, and to explore the risk factors. Methods: A case-control study was performed to retrospectively collect clinicopathological data of 764 patients undergoing laparoscopic D2 radical gastrectomy for gastric cancer at our department between January 2015 and December 2017. Patient inclusion criteria: (1) gastric cancer diagnosed by preoperative electronic gastroscopy and biopsy, and confirmed by postoperative pathology; (2) without invasion into adjacent organs by preoperative evaluation of tumors; (3) tumors without definite liver and distant metastasis; (4) R0 resection of gastric cancer and standard D2 lymph node dissection; (5) patients with informed consent. Exclusion criteria: (1) unperformed laparoscopic D2 radical resection; (2) other types of gastric tumor confirmed by pathology; (3) cases with incomplete clinical data. Complication occurring within two weeks after laparoscopic D2 gastrectomy was defined as early postoperative complication. Patients were divided into two groups: non-complication group (693 cases) and complication group (71 cases) according to the occurrence of complications after operation. The clinicopathological data of two groups were analyzed and compared with t test and χ² test, and the factors of P < 0.2 were included in the multivariate logistic regression model to analyze the risk factors of postoperative complications. Results: Of 764 patients, 71 (9.3%) developed early postoperative complications, with median onset time of 3 (1 to 11) days. Surgical complications accounted for 7.9% (60/764), including 13 cases (1.7%) of abdominal hemorrhage, 12 cases (1.6%) of anastomotic leakage, 10 cases (1.3%) of incision infection, 8 cases (1.0%) of anastomotic bleeding, 7 cases (0.9%) of gastric stump weakness, 4 cases (0.5%) of abdominal infection, 4 cases (0.5%) of duodenal stump leakage and 2 cases (0.3%) of small intestinal obstruction. Non-surgical complications accounted for 1.4% (11/764), including 6 cases (0.8%) of pulmonary infection and 5 cases (0.7%) of cardiovascular disease. Two cases (0.3%) died of sepsis caused by severe abdominal infection; 9 cases (1.2%) recovered after receiving the second operation, among whom 5 cases were abdominal hemorrhage, 2 cases were anastomotic leakage and 2 cases were duodenal stump leakage; the remaining patients were healed with conservative treatment. Compared with patients without complications, patients with complications had higher proportions of BMI ≥24 kg/m² [42.3% (30/71) vs. 24.2%(168/693), χ²=10.881, P=0.001], comorbity [64.8% (46/71) vs. 33.5% (232/693), χ²=27.277, P<0.001], combined organ resection [70.4% (50/71) vs. 20.5% (142/693), χ²=85.338, P<0.001], and pTNM stage of III [70.4% (50/71) vs. 40.1% (278/693), χ²=24.196, P<0.001], meanwhile had longer time to postoperative flatus [(4.2±2.1) days vs. (2.9±1.2) days, t=4.621, P=0.023], longer hospital stay [(34.6±12.6) days vs. (14.2±6.2) days, t=9.862, P<0.001] and higher hospitalization cost [(126.8±64.5) thousand yuan vs. (85.2±35.8) thousand yuan, t=11.235, P<0.001]. Multivariate analysis showed that BMI ≥24 kg/m² (OR=3.762, 95% CI: 1.960-8.783, P=0.035), accompanying disease (OR=8.620, 95% CI: 1.862-29.752, P<0.001), combined organ resection (OR=6.210, 95% CI: 1.357-21.568, P=0.026), and pTNM stage (OR=4.752, 95% CI: 1.214-12.658, P<0.001) were the independent risk factors of postoperative complications. Conclusions Laparoscopic D2 radical gastrectomy is a safe and effective approach for gastric cancer. Most early postoperative complications can obtain satisfactory efficacy after conservative treatment. Perioperative management should be strengthened for those patients with high BMI, accompanying diseases, combined organ resection, and advanced pTNM stage.

Objective    To explore whether surgery combined with adjuvant chemotherapy can bring survival benefits to patients with cervical and upper thoracic esophageal squamous cell carcinoma (ESCC). Methods    The clinical data of patients with cervical and upper thoracic ESCC who underwent R0 resection and neck anastomosis in our department from 2006 to 2010 were retrospectively analyzed. Patients received neoadjuvant therapy or adjuvant radiotherapy were excluded. The adjuvant chemotherapy group was given a combination of taxanes and platinum based chemotherapy after surgery; the surgery alone group did not receive adjuvant chemotherapy. The Kaplan-Meier method was used to analyze the survival difference between the adjuvant chemotherapy group and the surgery alone group. Results    A total of 181 patients were enrolled, including 141 (77.9%) males and 40 (22.1%) females, with an average age of 61.0±8.2 years (80 patients aged≤61 years, 101 patients aged>61 years). There were 70 (38.7%) patients of cervical ESCC, and 111 (61.3%) patients of upper thoracic ESCC. Eighty-seven (48.1%) patients underwent postoperative adjuvant chemotherapy, and 94 (51.9%) patients underwent surgery alone, and the basic clinical characteristics were well balanced between the two groups (P>0.05). The median survival time of patients in the adjuvant chemotherapy group and the surgery alone group was 31.93 months and 26.07 months, and the 5-year survival rate was 35.0% and 32.0%, respectively (P=0.227). There was no statistical difference in median survival time between the cervical ESCC and upper thoracic ESCC group (31.83 months vs. 29.76 months, P=0.763). For cervical ESCC patients, the median survival time was 45.07 months in the adjuvant chemotherapy group and 14.70 months in the surgery alone group (P=0.074). Further analysis showed that the median survival time of lymph node negative group was 32.53 months, and the lymph node positive group was 24.57 months (P=0.356). The median survival time was 30.43 months in the lymph-node positive group with adjuvant chemotherapy and 17.77 months in the lymph-node positive group with surgery alone. The survival curve showed a trend of difference, but the difference was not statistically significant (P=0.557). Conclusion    There is no statistical difference in the long-term survival of cervical and upper thoracic ESCC patients after R0 resection. Postoperative adjuvant chemotherapy may have survival benefits for patients with cervical ESCC and upper ESCC with postoperative positive lymph nodes, but the differences are not statistically significant in this setting.