Objective To summarize the clinicopathological characteristics and analyze the prognostic factors of young gastric cancer patients.Methods Data of 1 801 gastric cancer patients (divided into ≤45 years of age group,n =230 cases,and ＞ 45 years old group,n =1 571 cases) undergoing gastrectomy in Department of Gastrointestinal Surgery,Fujian Provincial Cancer Hospital,from June 1999 to November 2015 were retrospectively analyzed.Results Compared with the elderly patients,those ≤45 years old were more female with higher percentage of signet ring cell carcinoma,M1 and non radical resection while less in the upper stomach area (P ＜ 0.05),but there was no statistical difference in tumor size,depth of invasion,lymph node metastasis,Borrmann type,TNM stage,peripheral nerve involvement,cancer embolus,positive margin.Prognostic analysis showed the difference of 5-years survival rate was not statistically significant between young and elderly patients.But the 5-year survival rate in young patients with signet ring cell carcinoma undergoingt radical gastrectomy was better than that of elderly patients (P =0.047,0.038).Multivariate regression analysis showed that M staging and surgical modality were independent prognostic factors for these ≤ 45 years old patients.Conclusion Although there are special clinicopathological features of gastric cancer in young patients,but the postoperative prognosis is relatively the same as those elderly patients.

Objective To investigate the relationship between perineural invasion and clinicopathological factors of gastric cancer or prognosis of patients.Methods The retrospective case-control study was conducted.The clinicopathological data of 1 801 patients with gastric cancer who were admitted to the Affiliated Tumor Hospital of Fujian Medical University between March 1999 and November 2015 were collected.All the patients received surgery in order to the radical resection of gastric cancer,and total gastrectomy or two-thirds and above of gastrectomy and D2 lymph node dissection were performed.Patients with preoperative stage Ⅲ of clinical staging underwent neoadjuvant chemotherapy.Patients with T3-T4 of histopathologic stage,T1-T2 of positive lymph nodes and T2N0 of high risk factors (low differentiated tumor,lymphovascular invasion,perineural invasion and age ＜ 50 years) underwent postoperative chemotherapy.Observation indicators:(1) treatment situations;(2)pathological characteristics;(3) follow-up results;(4) prognostic factors.Follow-up using outpatient examination and telephone interview was performed once within 1 month postoperatively,once every 3 months within 2 years postoperatively and once every 6 months from 3 to 5 years postoperatively up to February 2016.Follow-up included inquiry,physical examination,routine blood test,biochemical test,carcinoembryonic antigen (CEA),CA19-9,color Doppler ultrasound or computed tomography (CT) and endoscopy.Measurement data with normal distribution were represented as (x)±s and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).Ordinal data was analyzed by the nonparametric test.The univariate analysis and multivariate analysis were done using the COX regression model.The hazard ratio (HR)and 95％ confidence interval (CI) were calculated.The survival curve and survival analysis were respectively drawn and done by the Kaplan-Meier method and Log-rank test.Result (1) Treatment situations:all the 1 801patients underwent traditional open surgery,including 1 570 undergoing radical resection and 231 undergoing palliative surgery.Of 1 801 patients,1 029 received total gastrectomy,540 received distal gastrectomy,201 received extended gastrectomy and 31 received resection of residual stomach.Operation time,volume of intraoperative blood loss,number of lymph node dissected and duration of hospital stay were (173±40) minutes,(224-±91) mL,30± 13 and (15±9) days,respectively.Of 1 801 patients,79 underwent preoperative neoadjuvant chemotherapy and 906 underwent postoperative adjuvant chemotherapy.(2) Pathological characteristics:results of pathological examinations of 1 801 patients showed that 509 had positive perineural invasion and 1 292 had negative perineural invasion.Tumors located in the upper region,middle region and lower region of stomach,whole stomach and stump stomach were respectively detected in 173,189,123,12,12 patients with positive perineural invasion and 395,417,428,29,23 patients with negative perineural invasion.Type Ⅰ,Ⅱ,Ⅲ and Ⅳ of Borrmann type were respectively detected in 13,213,244,39 patients with positive perineural invasion and 92,511,629,60 patients with negative perineural invasion.The good and poor tumor differentiations and tumor diameter ＜5 cm and ≥5 cm were respectively detected in 172,337,244,265 patients with positive perineural invasion and 536,756,833,459 patients with negative perineural invasion.Stage Ⅰ,Ⅱ,Ⅲ,Ⅳv of histopathologic stage,T1,T2,T3,T4 of invasive depth,NO,N1,N2,N3 of lymph node metastasis and positive and negative lymphovascular invasion were respectively detected in 27,54,346,82,17,24,26,442,77,84,109,239,383,126 patients with positive perineural invasion and 263,283,623,123,188,169,289,646,409,219,312,352,437,855 patients with negative perineural invasion,with statistically significant differences in above indexes between positive and negative perineural invasion patients (X2 =14.142,Z =-2.098,X2 =9.061,41.536,Z=-10.389,-13.824,-8.638,X2 =252.624,P＜ 0.05).(3) Follow-up results:1 629patients were followed up for 1.0-99.0 months,with a median time of 37.3 months.The 5-year overall survival rate was 58.5％.(4) Prognostic factors:results of univariate analysis showed that tumor location,Borrmann type,degree of tumor differentiation,tumor diameter,histopathologic stage,invasive depth,lymph node metastasis,lymphovascular invasion and perineural invasion were factors affecting prognosis of patients with gastric cancer (HR=1.209,1.303,1.496,2.303,3.368,2.057,1.812,2.013,1.332,95％ CI:1.123-1.301,1.171-1.449,1.290-1.736,2.001-2.649,3.012-3.767,1.856-2.279,1.694-1.939,1.749-2.317,1.126-1.576,P＜0.05).Resuhs of multivariate analysis showed that tumors located in the upper and middle of stomach,whole stomach and stump stomach,tumor diameter ≥ 5 cm,stage Ⅱ-Ⅳ of histopathologic stage,T2-T4 of invasive depth,N1-N3 of lymph node metastasis,positive lymphovascular invasion and positive perineural invasion were independent risk factors affecting prognosis of patients with gastric cancer (HR =1.087,1.234,2.663,1.174,1.136,1.254,1.272,95％ CI:1.008-1.172,1.063-1.432,2.292-3.095,1.035-1.332,1.044-1.236,1.064-1.501,1.066-1.516,P＜0.05).The 5-year survival rate was 49.1％ in 509 patients with positive perineural invasion and 60.7％ in 1 292 patients with negative perineural invasion,respectively,with a statistically significant difference (X2 =11.270,P＜0.05).The 5-year overall survival rate was 41.1％ in 383patients with positive perineural invasion and lymphovascular invasion,77.1％ in 126 patients with positive perineural invasion and negative lymphovascular invasion,49.1％ in 437 patients with negative perineural invasion and positive lymphovascular invasion and 92.1％ in 855 patients with negative perineural invasion and lymphovascular invasion,respectively,with a statistically significant difference (X2=244.368,P＜0.05).Conclusion Perineural invasion is a high risk factor affecting prognosis of patients with gastric cancer,and it may be useful in evaluating prognosis of patients with gastric cancer.

Objective:To clarify the evidences of hippocampal injury after radiotherapy avoiding hippocampus and explore its relationships with cognition.Methods:A prospective design was adopted in this study.A total of 183 patients with nasopharyngeal carcinoma treated by intensity modulated radiation therapy (IMRT group) and 30 matched healthy control (HC group)were collected in the Affiliated Hospital of Jiangsu University and Southeast University Affiliated Zhongda Hospital from January 2017 to December 2019. All subjects were assessed by Montreal Cognitive Assessment (MoCA-B) at baseline and 6 months after radiotherapy, then the patients with nasopharyngeal carcinoma were divided into cognitive impairment group and non-cognitive impairment group. Subjects were scanned with Siemens 3.0 T MR, and T 1WI was used as analysis sequence.The individual standardized hippocampus ROIs were extracted based on Montreal Neurological Institute(MNI) brain template.All texture features were calculated using the Radiomics developed by C++and Delphi, and the intra group correlation coefficients (ICC), average direction, machine learning (random forest) and autocorrelation matrix were used for reducing the features dimension. One-way ANOVA and generalized linear models were used to compare the differences among different groups. Pearson correlations analyses were used to evaluate the relationships between important texture features and clinical data. Logistic regressions were used to calculate the abilities of texture features to predict cognitive impairment. Results:After 9 patients who lost follow-up were excluded, a total of 164 patients with nasopharyngeal carcinoma were included as IMRT group.Texture features of ROIs were extracted and dimensionally reduced successfully. Five differences features (Variance, Entropy, GlevNonU, RLNonUni and Contrast)were found among HC group, cognitive impairment group and non-cognitive impairment group, and the last three further showed significant differences within IMRT group (GlevNonU, P=0.011;RLNonUni, P<0.001;Contrast, P<0.001). Hippocampal doses were positively correlated with Variance ( r=0.448, P<0.05), and negatively correlated with Entropy ( r=-0.461, P<0.05). There was a positive correlation between MoCA-B scores with GlevNonU, RLNonUniand Contrast ( r=0.503, P<0.05; r=0.587, P<0.05; r=0.531, P<0.05). GlevNonU and Contrast were independent predictors of cognitive impairment in hippocampal avoidance of radiotherapy (OR=0.731, 95%CI 0.610-0.857; OR=0.651, 95%CI 0.496-0.853). Conclusion:Results of texture analysis could be used as micro imaging evidences of hippocampal injury in radiotherapy avoiding hippocampus, and could also effectively predict the occurrences of cognitive impairment.

Objective:To investigate the safety and prognostic value of neoadjuvant chemotherapy and surgery for advanced gastric cancer patients with para-aortic lymph node metastasis.Methods:Clinicopathological data of 25 patients admitted to the Department of Gastrointestinal Surgery, Fujian Cancer Hospital from Jan 2015 to Jun 2017 were retrospectively analyzed. All patients were treated with SOX chemotherapy for 3 cycles. D 2 + paraaortic lymphadenectomy was performed in patients with stable disease (SD) . After operation, SOX regimen was used for 5 cycles of chemotherapy. Results:After 3 cycles of neoadjuvant chemotherapy, there were 2 cases with progressive disease, 6 cases of SD and 17 cases of partial remission. There was no treatment-related death. Twenty-three patients underwent surgery, including 19(76%) patients of R 0 resection. Tirty-four out of 128 para aortic lymph nodes were metastatic. Postoperative complications occurred in 5(22%) patients, with no mortality . The median progression free survival time and median overall survival time were 20 and 29 months respectively. The 1, 3-year overall survival rates were 80% and 48%, and the 1-year and 3-year progression free survival rates were 72% and 38%, respectively. For those with para-aortic lymph node metastasis the 1-year and 3-year OS rate were 70% and 17%, respectively. Multivariate analysis showed that the efficacy of neoadjuvant chemotherapy was an independent prognostic factor. Conclusion:Neoadjuvant chemotherapy is among others an independent prognostic factor affecting the post-op survival of advanced gastric carcinoma with para-aortic lymph node metastasis.

OBJECTIVETo evaluate the safty and feasibility of the D2 radical resection of omental bursa and No.12p and No.8p for gastric carcinoma (GC).

METHODSClinical data of 1801 GC patients undergoing D2 radical resection of omental bursa and No.12p and No.8p at Fujian Medical University Cancer Hospital from January 2000 to January 2010 were analyzed retrospectively. Inclusion case criteria: (1)age of 18 to 90 years;(2)pathologically diagnosed as GC and receiving D2 radical resection of omental bursa and No.12p and No.8p;(3)complete clinical, pathological and follow-up data; (4)operation performed by same leading surgeon;(5)exclusion of other gastric malignancies, postoperative relapse of GC, and other simultaneous or heterochronous primary malignancies. Surgical procedure points: (1)The outer part of the peritoneum of duodenum descending was cut; the serosa was migrated to the anterior leaf of the gastrointestinal ligament. (2)The posterior lobe of the gastrocolic ligament and the transverse mesocolon were separated bluntly from left side to reach the omentum attaching to the colon portion; incision was made at the edge of the omentum attaching to the transverse colon behind the gastrocolic ligament; the leaves were turned to the anterior mesenteric anterior leaflets, and the entire anterior leaflet of the transverse mesentery was free.(3)The pancreas was separated, and resection of the posterior wall of the omentum sac continued up so that the entire retinal capsule was free; along the edge of the liver the attachment of the omentum was cut to reach the front of esophagus, and transverse incision was made in abdominal peritoneal layer of the esophagus, and then turned to the spleen on the pole; from the obturator to the esophagus incision was performed behind the peritoneum for the net; the uppermost edge of the resection of the capsule was performed as the posterior peritoneal incision to the right edge of the esophagus and was connected with the posterior parietal lobe of the previous resection; the posterior peritoneum was attached along the right edge of the esophagus and descended to the celiac artery; the posterior wall of the omental sac was removed. In the meantime, the liver duodenum ligament was cut, and the portal vein, hepatic artery trilocular was formed. Then the ligament lymph nodes were cleared.(4)The lymph nodes of celiac artery and its major branches were cleared; the envelope in front of pancreas and the part of the pancreas in posterior abdomen were resected; spleen and part of the pancreas tail were free.

RESULTSA total of 1801 cases were enrolled, including 1292 males and 509 females with a ratio of 2.54 with a mean age of(58.9±11.5)(18 to 89) years. The proportion of cases with T1a, T1b, T2, T3, T4a and T4b was 4.8% (87 cases), 6.6% (118 cases), 10.7% (193 cases), 17.5% (315 cases), 55.7% (1003 cases) and 4.7%(85 cases) respectively. All the patients completed operations successfully. The mean number of harvested lymph node was 28.5±13.7(10 to 85). Lymph node metastasis was found in 1439 cases (79.9%), including 180 cases (10.0%) in No.12p and 232 cases(12.9%) in No.8p respectively. Subgroup analysis showed that in T1a, T1b, T2, T3, T4a and T4b stage, the proportion of No.12p was 0, 1.7% (2/118), 5.2%(10/193), 10.5% (33/315), 12.4% (124/1003) and 12.9%(11/85) respectively, and the proportion of No.8p was 0, 0.8%(1/118), 2.1%(4/193), 4.8%(15/315), 18.9%(190/1003), and 25.9%(22/85) respectively. Postoperative complications were found in 195 patients (10.8%), including 63 cases(3.5%) of peritoneal infection, 52 cases (2.9%) of pulmonary infection, 33 cases(1.8%) of pancreatic leakage, 37 cases (2.1%) of anastomotic fistula, 45 cases (2.5%) of intestinal obstruction and 13 cases(0.7%) of gastroplesia. The 5-year overall survival rate was 53.6%.

CONCLUSIOND2 radical resection of omental bursa and No.12p and No.8p is safe and feasible in the treatment of gastric cancer.

Objective To analyze the relationship of lymphovascular invasion (LVI) and the clinical pathological feature of gastric cancer and impact on the prognosis in gastric cancer patients.Methods The clinical and pathological data of 1 482 gastric cancer patients undergoing gastrectomy were analyzed retrospectively.The relationship between LVI and the prognosis was evaluated.Results LVI was found in 606 patients (40.9％),which was in significant correlations with tumor size,tumour location,Borrmann type,tumor differentiation status,operative method,tumor invasion,lymph node involvement,and TNM stage (P ＜ 0.05).The five-year survival of patients with LVI was significantly shorter than that of the LVI-negative patients (55.0％ vs.73.1％,x2 =45.15,P =0.00).By multivariate analysis,LVI was an independent prognostic factor (HR =1.592,95％ CI:1.329-1.907,P =0.00).Conclusion LVI is au important indicator for poor prognosis of gastric cancer,suggesting a more aggressive postoperative therapies.

Objective To explore the safety and long-term results of preoperative imatinib mesylate administration (IM) in patients with locally advanced gastrointestinal stromal tumors (GIST).Methods From Sep 2009 to Nov 2016,locally advanced GIST patients treated in Fujian Medical University Cancer Hospital were analysed retrospectively.Result 34 patients were included.Preoperative median IM treatment was 27 weeks(range 12-71 weeks).65％ patients had a partial response to IM,35％ showed stable disease.All patients underwent surgical R0 resection.The complication rate was 9％ and no death occurred within 30 days post operation.The median follow-up time was 62.2 months (range of 13-89 months).20 patients continued to take imatinib orally,14 patients did not.The 3 year survival rate of patients undergoing surgery was 67％.Univariate analysis showed that tumor location,preoperative imatinib effect,pathology,targeted therapy after surgery were factors affecting prognosis.Multivariate analysis show that the independent risk factors affecting prognosis were tumor location,pathology,targeted therapy after surgery.Conclusion In locally advanced GISTs,preoperative IM is useful and safe that can effectively decrease tumor size,facilitating resection.

Objective:To investigate the knowledge and compliance status of prevention and control of brucellosis among high-risk populations in counties and districts with high incidence of brucellosis in Xinjiang Uygur Autonomous Region (Xinjiang for brief), and to provide scientific basis for prevention and control of brucellosis and health education for high-risk populations.Methods:Huocheng County, a high incidence county of brucellosis in Xinjiang, was selected as the survey site. Three to six townships were selected, and two to three administrative villages were selected from each township as the survey villages. People over 18 years old and engaged in livestock breeding such as cattle and sheep breeders, livestock product processors, veterinarians and medical personnel were selected as the survey subjects. Face-to-face surveys were conducted by professional trained investigators in autumn and winter (December 2019 to January 2020) and spring and summer (April to July 2020). The survey included general demographic information, awareness of brucellosis prevention and control knowledge and the use of protective equipment.Results:A total of 600 people were surveyed, and 597 people completed the questionnaire, with an effective response rate of 99.50% (597/600). The overall awareness rate of brucellosis prevention and control knowledge was 68.23% (10 184/14 925), among which the awareness rate of clinical symptoms of human infection with brucellosis was high, at 73.53% (3 073/4 179). There were statistically significant differences in the awareness rate of main source of infection, main transmission route and clinical symptoms of human infection with brucellosis among people of different gender, age, nationality, education level and occupation ( P < 0.05). Among them, the awareness rate of clinical symptoms of human infection with brucellosis among veterinarians and medical personnel was 85.38% (514/602). The utilization rate of protective equipment such as rubber shoes and work clothes was high, which was 63.48% (379/597) and 60.97% (364/597), respectively. There were statistically significant differences in the utilization rate of protective equipment among different nationality, education level and occupation ( P < 0.05). Among them, The utilization rate of work clothes was the highest among people with college education or above, veterinarians and medical personnel, which was 82.61% (57/69) and 93.02% (80/86), respectively. Conclusions:The overall awareness rate of brucellosis prevention and control knowledge in high-risk groups in Huocheng County of Xinjiang is low, especially among high-risk groups such as those who are illiterate or have little literacy, and farmers, the awareness rate is low and the awareness of prevention and control is weak. There is a risk of brucellosis infection. It is necessary to further strengthen the education of brucellosis prevention and control knowledge among these groups.

BACKGROUND:The use of vancomycin in total knee arthroplasty is a controversial strategy for the prevention of incisional infection.At present,there is little evidence to evaluate the efficacy of this preventive measure in China. OBJECTIVE:To evaluate the efficacy of local vancomycin in the prevention of early postoperative incision infection during total knee arthroplasty. METHODS:120 patients with osteoarthritis of the knee who received unilateral total knee arthroplasty for the first time at Department of Joint Surgery of First Affiliated Hospital of Anhui Medical University from March to June 2022 were included in this study.They were randomly divided into the observation group and the control group,with 60 cases in each group.All patients gave informed consent to the treatment plan.In the observation group,1 g of vancomycin was applied intraoperatively;in the control group,no vancomycin was applied intraoperatively.Erythrocyte sedimentation rate,C-reactive protein,fever rate on seven consecutive days after surgery,degree of knee joint swelling,cumulative drainage volume,and incidence of periprosthetic joint infection were recorded in two groups of patients on days 1,3,and 5 after surgery so as to evaluate the efficacy of topical vancomycin in total knee arthroplasty for the prevention of incision infection in the early postoperative period. RESULTS AND CONCLUSION:(1)The differences in erythrocyte sedimentation rate and C-reactive protein between the two groups on days 1,3,and 5 after surgery were not significant(P>0.05).(2)The difference in fever rate between the two groups for 7 consecutive days after surgery was not significant(P>0.05).(3)There was no significant difference in the degree of postoperative knee swelling and cumulative drainage flow between the two groups(P>0.05).(4)The difference in the incidence of periprosthetic joint infection one year after surgery was not significant between the two groups(P>0.05).(5)The results suggest that the local use of vancomycin in total knee arthroplasty has not shown significant efficacy in preventing incision infection in the early postoperative period.

Objective To analyze the risk factor of delayed gastric emptying (DGE) and the impact of DGE on prognosis after radical gastrectomy of distal gastric carcinoma.Methods The clinical and pathological data of 1 447 distal gastric cancer patients undergoing gastrectomy from Jul 2007 to Jan 2018 at Fujian Tumour Hospital was analyzed retrospectively.Result DGE was found in 101 patients (7.0％),occurring at a median of (6.0 ± 2.1) d after surgery.It was significantly correlated with age,diabetes,hypoproteinemia,preoperative pyloric obstruction,operation time,surgical mode,anastomotic procedure,postoperative analgesia(all P ＜ 0.05).Multivariate analysis showed that hypoproteinemia,diabetes,pyloric obstruction in preoperative period,surgical mode,postoperative analgesia,anastomotic procedure were independently associated with DGE.The average hospitalization time for DGE was significantly higher than patients with non DGE(16.3 ± 4.2) d vs.(8.1 ± 2.1) d,P ＜ 0.05.The five-year survival of patients with DGE and non DGE were 54.9％ and 54.2％ respectively(P ＞0.05) Conclusion DGE prolonged hospital stay,but did not influence patients' prognosis.