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.

0.05). The valve competence recovery rate in severe PDVI group was significantly lower than that of the mild and moderate PDVI groups (both P

Objective To evaluate the safety and therapeutic effect of covered expandable metallic stent placement combined with interventional chemotherapy in treating malignant esophago-tracheal fistulae. Methods A total of 60 patients with esophago-tracheal fistula were enrolled in this study. The patients were randomly divided into control group (n=28) and study group (n=32). Patients of the control group were treated with covered stent implantation only, while patients of the study group were treated with combination use of covered stent implantation and interventional chemotherapy. All the patients were followed up regularly, the short-term and long-term results were determined, and the effect rate, median survival time and complications were statistically analyzed. Results Among the 60 patients, successful obstruction of the fistula was obtained in 58 with a success rate of 96.7%. The median survival time of the 58 patients was 5.8 months. The median survival time of the control group and the study group was 3.6 months and 8.7 months respectively, the difference between the two groups was statistically significant (P<0.05). The one-month, 3-month and 6-month effect rates were 78.1%, 68.8% and 62.5% respectively. The incidence of esophageal stent re-stenosis in the study group was much lower than that in the control group. Conclusion The combination use of covered stent implantation and interventional chemotherapy can effectively improve the median survival time of patients with malignant esophago-tracheal fistula, and reduce the occurrence of stent-related complications. Therefore, covered expandable metallic stent placement combined with interventional chemotherapy is an effective and safe treatment for malignant esophago-tracheal fistulae.

According the development requirement of medical imaging skill,centered on diseases,we discussed the teaching reform of imaging diagnostics course,including the optimized integration of the course,bilingual teaching,teaching methods,format of subject test and strengthening practice teaching,hoping to improve the whole team' professional quality.

Objective To explore the change of cellular immune function in renal cancer patients adopting thymopetidum (TP-5) combined with cytokine-induced killer cells (CIK) in peroperative period,and evaluate its curative effect.Methods Forty-one cases of Ⅰ-Ⅲ stage renal cancer patients adopting CIK treatment postoperatively were enrolled in this study for retrospective analysis.According to applicating condition of TP-5,the patients were divided into two groups:16 cases of combination group (TP-5+CIK) and 25 cases of CIK group.The patients in combination group were given TP-5 intramscular injection everyday from preoperative 1 d to postoperative 3 weeks,once a day.Peripheral blood mononuclear cell was collected in the patients of two groups,which was cultivated for 2 weeks and then transfused.Fasting peripheral blood 1 week (before collected peripheral blood mononuclear cell),3 weeks (before CIK retransfusion),4 weeks(after CIK retransfusion for 1 week) and 5 weeks(after CIK retransfusion for 2 weeks) after operation were examined,the peripheral blood T cell subgroups (CD3+,CD4+,CD8+) and nature killer cell (NK cell) levels were detected using flow cytometry.Results At 1 week and 3 weeks (before CIK) after operation,the levels of CD3+,CD4+/CD8+ and NK cell in combination group were significantly higher than those in CIK group:1 week after operation:0.542 ± 0.063 vs.0.491 ± 0.054,0.94 ± 0.09 vs.0.90 ± 0.12,0.247 ± 0.025 vs.0.223 ± 0.033;3weeks after operation:0.641 ±0.058 vs.0.587 ±0.062,1.71 ±0.13 vs.1.02 ±0.07,0.319 ±0.038 vs.0.264 ± 0.047).There were significantly differences (P＜ 0.05).At 4 weeks after operation,the levels of CD3+,CD4+/CD8+ and NK cell in combination group were significantly higher than those in CIK group:0.698 ± 0.041vs.0.649 ± 0.050,2.01 ± 0.11 vs.1.64 ± 0.09,0.331 ± 0.029 vs.0.289 ± 0.034.There were significantly differences (P ＜ 0.05).At 5 weeks after operation,the levels of CD3+,CD4+/CD8+ and NK cell in two grotups were no significant difference (P ＞ 0.05).At 4 and 5 weeks after operation,the levels of CD3+,CD4+/CD8+ and NK cell in two groups were significantly higher than those of 3 weeks after operation (P ＜ 0.05).None of patients occurred acratia,hyperpyrexia,shivering and so on.Conclusions The application of TP-5 treatment in peroperative period can promote the recovery of cellular immune function,which has synergistic effect with CIK.The value of TP-5 is worthy of promotion.

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 understand the change of smoking status among middle school students in Quzhou City from 2012 to 2017, and to provide a basis for school tobacco control. Methods: Through stratified cluster sampling method, Zhejiang youth health-related behavior questionnaire survey was conducted among 1 454 students in May 2012 and among 1 655 students in May 2017. Results: Among middle school students in Quzhou, attempting smoking rate, ever-smoking a whole cigarette reporting rate and current-smoking report rate decreased from 31.36%, 17.81% and 8.73% in 2012 to 21.70%,12.45% and 6.22% in 2018 respectively, with statistically significant differences(χ2=37.30,17.52,7.12,P<0.01). Among the current-smoking students, the rate of smoking frequency≥20 d/month and heavy-smoking rate decreased from 30.71% and 7.09% in 2012 to 15.53% and 0.97% respectively. It showed that attempting smoking rate, ever-smoking a whole cigarette reporting rate and current-smoking report rate of male students were higher than that of female students(χ2=117.50,63.99;47.14,51.26;110.18,22.50), and the non-ordinary high school students were higher than that of ordinary high school students and middle school students across two waves surveillance(χ2=47.14,51.26;70.34,43.77;62.67,22.50)(P<0.01). Conclusion School tobacco control have made a great progress，the tobacco use behavior of middle school students declines sharply in Quzhou.

Methods:A retrospective case-series study was performed to analyzed the data of 38 patients (38 feet) with displaced intra-articular calcaneal fractures admitted to Xuzhou Central Hospital from January 2016 to May 2018. There were 21 males (21 feet) and 17 females (17 feet), with the age of (33.7±6.2)years (range, 21-53 years). According to the Sanders' classification, 7 patients were classified as type II, 27 as type III and 4 as type IV. All patients underwent the procedure of subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon procedure. The operation time, intro-operative management, incision healing, and post-operative complications (nerve, vessels and tendon injuries)were recorded. B?hler angle, Gissane angle, length, width and height of the calcaneus, and bone healing time were recorded at postoperative 2 days and at final follow-up. The visual analogue score (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scale, and Foot and Ankle Outcome Score (FAOS) were recorded at final follow-up, and were used to evaluate the clinical and functional outcomes.Results:All patients were followed up for 12-42 months [(18.7±5.3)months]. The operation time ranged from 45 to 100 minutes [(72.4±22.6)minutes]. Bone grafting was not observed, and microfracture of the posterior articular surface of the calcaneus were involved in 9 patients. The first-stage incision healing was achieved in all patients, without early complications of nerve, vessel and tendon injuries. The post-operative angles of B?hler and Gissane, length, width and height of the calcaneus were significantly improved compared to preoperative values ( P<0.01), while there were no significant difference at postoperative 2 days and at final follow-up ( P>0.05). At final follow-up, the VAS decreased from 5(3, 9)points to 0(0, 3)points, AOFAS improved from (68.3±10.5)points to (90.6±5.0)points, and FAOS improved from (66.9±9.1)points to (89.8±4.3)points, respectively ( P<0.01). According to the AOFAS ankle and hindfoot scale, the result was excellent in 27 patients, good in 8, and fair in 3, with the excellent and good rate of 92%. Conclusions:For displaced intra-articular calcaneal fractures, subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon has advantages of precise fracture reduction, low postoperative complications and reliable functional outcomes.

Objeetive To evaluate the performance characteristics of the second trimester double test for the detection of fetal Down's syndrome(DS)in women of advanced maternal age(AMA).Methods We undertook a prospective nation-wide multi-centered study and chose alpha-fetoprotein(AFP))and free β-subunit of human chorionic gonadotrophin(free β-hCG)as the serum markers.Between May 2004 and September 2006,12 centers participated in the collection and analysis of maternal serum AFP and free β-hCG.Patients with an iuereaged risk of DS(≥1/270)wero offered generic sunniocentesis.Follow up of the outcome of all pregnancies was obtained.Patients were divided into two groups,the AMA group and the non-AMA group and the screening efficiency Was evaluated in beth groups.Results A total of 66 132 singleton pregnancies were included in the study.and there were 36 10(5.46%)AMA women.The median maternal age of AMA women was 36.8years(35-47 years).At a cut-off of 1/270,in the AMA group,the number of positive cases screened was 727 and 22 cases of fetal DS were detected:the number of negative cases screened was 2883,and no fetal DS was found.In the non-AMA group,the number of positive cases screened was 4743 and 69 cases of fetal DS were detected:the number of negative cases screened was 57 779,and 6 cases of fetal DS were diagnosed postnatally.In AMA group,the detection rate(DR),false positive rate(FPR)and odds of being affected given a positive result(OAPR)were 100%,19.7%and 3.0%respectively.In the non-AMA group,the DR,FPR and OAPR were 92.0%.7.5%and 1.5%respectively.Conclusion The double-marker test using AFP and free β-hCG is an effective screen strategy for second-trimester detection of Down syndrome in AMA women.

Objective:To investigate the application effect of problem-based learning (PBL) in the teaching of professional postgraduate students in hepatobiliary surgery.Methods:A total of 60 professional postgraduate students in the same grade who were accepted by Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, were selected as research subjects. The students were randomly divided into PBL teaching group and lecture-based learning (LBL) teaching group, and the training effect was compared between the two groups. SPSS 25.0 software was used for t test and chi-square test. Results:Compared with the LBL group, the PBL group had significantly higher scores of written examination [(90.3±4.5) vs. (85.2±7.1), P<0.05] and skill examination [(92.3±4.9) vs. (86.3±7.9), P<0.05] and significantly better comprehensive abilities such as scientific research ability, clinical ability, organizing ability, literature review, collaboration and cooperation, and language expression [(85.0±7.5) vs. (73.0±9.1), P<0.05], as well as a significantly higher overall evaluation score [(90.2±3.2) vs. (83.3±3.9), P<0.05]. The PBL group also had a higher degree of satisfaction than the LBL group (83.3% vs. 56.7%). Conclusion:Application of PBL in the teaching of professional postgraduate students can improve the quality of teaching.