Objective: To explore the application effect of preoperative administration of immunomodulating enteral nutrition for gastric cancer. Methods: From January 2016 to December 2017, 90 cases with gastric cancer in the Second People′s Hospital of Lianyungang were selected and randomly divided into observation group, control group A and control group B, with 30 cases in each group.The observation group was given enteral nutrition emulsion(TPFT, Ruineng) before and after operation, the control group A was given Ruineng before operation and the enteral nutrition emulsion(TP, Ruisu) after operation, the control group B was given Ruisu before operation and Ruineng after operation.The recovery, serum markers of nutritional status and immune function were evaluated and compared, and the postoperative situations were observed. Results: There were no statistically significant differences in the total protein, albumin, prealbumin and transferrin among the three groups during admission, 1 day before operation and 5 days after operation(all P>0.05). There was no statistically significant difference in immune indicators among the three groups during admission and 1 day before operation(all P>0.05). At 5 days after operation, IgA, IgM, IgG, CD₄⁺ and CD4/CD8 in the observation group were (2.9±0.6)g/L, (1.4±0.4)g/L, (12.4±0.9)g/L, (37.4±5.1)%, (2.2±0.7), respectively, which were significantly higher than those in the control group A[(2.3±0.8)g/L, (1.1±0.6)g/L, (10.8±0.8)g/L, (34.2±4.8)%, (1.7±0.8), respectively, t=3.324, 2.250, 7.100, 2.506, 2.660, all P<0.05], the IgA and CD4/CD8 in the observation group were higher than those in the control group B[(2.6±0.8)g/L, (1.9±0.7), t=2.021, 2.127, all P<0.05]. The postoperative exhaust time of the observation group, control group A and control group B were (56.4±7.8)h, (78.6±10.4)h, (60.7±10.6)h, respectively, and the postoperative exhaust time of the observation group was significantly shorter than that of the control group A(t=9.323, P<0.05). There was no statistically significant difference in the gastrointestinal symptoms and postoperative complications among the three groups (P>0.05). Conclusion In perioperative period, immunomodulating enteral nutrition has little effect on the nutritional indicators of patients with gastric cancer and the incidence of postoperative complications, but it can improve the immune function.

Objective: To compare the effects of laparoscope and open complete mesocolic excision (CME) in the treatment of right colon cancer. Methods: The retrospective case-control study was adopted.The clinical data of 139 patients with right colon cancer who underwent CME at the Second People's Hospital of Lianyungang from January 2014 to November 2017 were collected.The patients were divided into laparoscopy group(55 cases) and open group(84 cases). The postoperative recovery and oncology efficacy were compared. Results: The operation time in the laparoscopy group[(172.8±25.9)min]was longer than that in the open group[(142.3±20.6)min](t=7.387, P<0.05), but the blood loss of the laparoscopy group[(111.6±36.7)mL] was less than that in the open group[(150.1±61.1)mL](t=4.017, P<0.05). There was no statistically significant difference in numbers of lymph nodes harvested.Compared with open group, there were advantages in the laparoscopy group such as less anal exhaust time, less postoperative eating liquid diet time and shorter hospitalization time, the differences were statistically significant (t=4.695, 5.517, 4.642, all P<0.05). There was no statistically significant difference in postoperative complication rate (P>0.05). There were no statistically significant differences in the cumulative recurrence rate, cumulative survival rate and cumulative survival rate between the two groups after 3 years (all P>0.05). Conclusion Laparoscopic CME is minimally invasive and quick recovery, and laparoscopic CME has the same oncologic clearance effects, and is worthy of clinical application.

Objective:To preliminarily observe the clinical efficacy of microwave hyperthermia combined with intensity-modulated radiotherapy (IMRT) and chemotherapy for patients with locally advanced gastric cancer.Methods:Forty patients who could not been operated or refused operation were enrolled in this clinical trial, who were confirmed as locally advanced proximal or distal gastric cancer by gastroscopy pathology and imaging. Radiotherapy was delivered by IMRT technology for 5 times per week with a total dose of 46 to 56 Gy (median dose of 50 Gy) in 25 to 28 fractions. Synchronous hyperthermia was given at 42 to 44℃ twice a week, 45 min/time. S-1 or capecitabine-based synchronous chemotherapy was performed, d1-14/3 weeks. The symptom remission rate, adverse reactions, objective remission rate (complete and partial remission) and survival were observed.Results:A total of 40 patients, aged between 56 and 83 years (median age of 71 years), were enrolled in this study. The male-to-female ratio was 7: 1. Among them, 38 cases (95%) showed symptom remission. The most common adverse reactions were grade 1-2 gastrointestinal reactions and leukopenia. The objective remission rate was 87.5%, the 2-year progression-free survival and overall survival rates were 68.6% and 70.5%, respectively.Conclusion:Preliminary findings demonstrate that microwave hyperthermia combined with chemoradiotherapy achieve satisfactory outcomes and yield tolerable toxicity in patients with locally advanced gastric cancer.

Objective:To explore genes related to costimulatory molecule related to the prognosis of bladder cancer,and to construct and evaluate prognosis model based on costimulatory molecule-based signature(CMS).Methods:Gene expression matrix and clinical information of bladder cancer patients were downloaded from TCGA database and GEO database(GSE31684),and costimulatory molecule-related genes were retrieved from the literature.The univariate and multivariate Cox analysis were used to screened prognostic-related genes and constructed prognostic model.Forecast accuracy of model was verified in TCGA training group,TCGA validation data group and GEO group by Kaplan-Meier survival analysis and receiver operating characteristic curve(ROC).Considering risk score and clinical characteristics,we constructed a nomogram and evaluated its performance by consistency analysis and ROC.CIBERSORT algorithm was used to analyze immune cell composition of tumor microenvironment infiltration,and gene set enrichment analysis(GSEA)was performed to explore the potential mechanism.Results:Four prognostic-related CMSs were found:TNFRSF14,CD276,ICOS and TMIGD2,of which three were included in the risk score construction.Multivariate Cox regression results showed that the risk score based on CMS was an independent prognostic factor for bladder cancer patients.Consistency analysis and ROC results showed that the nomogram had ideal prognosis prediction accuracy.Immune infiltration analysis showed that the high risk group was likely to be in immunosuppressive state.GSEA results suggested that genes in high risk group were enriched in extracel-lular matrix(ECM)receptors interaction,cell cycle and other pathways.Conclusion:TNFRSF14,CD276 and ICOS may be potential prognostic biomarkers for bladder cancer patients.CMS-based risk score and nomogram could contribute to early prognosis and choice of personalized treatment.

Objective To explore the influence of cucurbitacin E (CuE) on autophagy in human bladder cancer cell line T24 and further study its impacts on cell proliferation. Methods MTT assay was used to determine the proliferation inhibition capacity of CuE on T24 and western blot to check the impacts of CuE treatment on the expression of classic autophagy markers LC3A/B and p62. LC3 turnover assay and GFP-RFP-LC3 fluorescent assay were performed to determine autophagy flux. Western-blot was used to check the autophagy inhibition ability of 3-MA on CuE treatment and MTT assay and cell counting assay were used to check the influence of CuE-induced autophagy on cell proliferation with/without autophagy inhibition. Results CuE inhibited the proliferation of T24 and the IC50 in 24 h was about 0.75 μmol/L. CuE treatment increased the expression of LC3A/B Ⅱ and LC3A/B Ⅱ/Ⅰ ratio (P < 0.05) , but decreased the expression of p62 (P < 0.05) , indicating the induction of autophagy. Autophagy flux was induced because of positive LC3 turnover assay and the increase of yellow and red dots in GFP-RFP-LC3 fluorescent assay (P < 0.05). CuE-induced autophagy was inhibited by 3-MA (P < 0.05). With autophagy inhibition, CuE's proliferation suppression ability on T24 was attenuated (P <0.05). Conclusion CuE induces autophagy in bladder cancer cell line T24 and the induced autophagy positively contributes to the inhibitation of cell proliferation.

Objective:To investigate the basic knowledge of chronic obstructive pulmonary disease (COPD) among physicians in primary hospitals (county and township hospitals) in Shanxi province.Methods:A electronic questionnaire survey that included questions on basic knowledge, epidemiology, diagnosis and management of COPD was conducted. The questionnaire was distributed through Wechat communication by convenient sampling among physicians and respiratory specialists in primary hospitals in Shanxi province.Results:A total of 1 162 questionnaires were collected, among which 1 100 were valid (882 from county hospitals and 218 from township hospitals). The results showed that 768 (69.8%) considered that smoking and biomass fuel exposure were the main risk factors of COPD, while 639 (58.1%) thought that COPD patients needed to quit smoking. Only 334 respondents (30.4%) indicated that their COPD knowledge was derived from guidelines; 764 respondents (69.5%) considered pulmonary function tests as the gold standard for diagnosing COPD, but only 407 (37.0%) provided correct answers for the specific criteria of pulmonary function, and only 98 respondents (8.9%) correctly identified the diagnostic criteria for severe COPD. In comparison with the county hospital group, fewer doctors in the township hospitals received their COPD knowledge from guidelines [23.9%(52/218) vs.32.0%(282/882), χ 2=5.450, P<0.05]; more doctors in the township hospitals experienced difficulties in the diagnosis and treatment of COPD, including inadequate spirometers in their hospitals [59.6%(130/218) vs. 45.2% (399/882), χ 2=14.509, P<0.01] and significantly inadequate COPD medications [42.7%(93/218) vs.34.2%(302/882), χ 2=5.385, P<0.05]. Significantly lower proportions of general physicians performed pulmonary function tests for COPD patients (χ 2=12.638, P<0.01) and provided correct answers for the diagnostic criteria for severe COPD [6.6%(46/692) vs. 12.7%(52/408), χ 2=11.760, P<0.01] in comparison with respiratory specialists. Conclusions:Doctors in primary hospitals in Shanxi have an inadequate knowledge of COPD. Strengthening COPD-related education and promoting the use of guidelines among doctors remain important issues for successful management of COPD.

Objective:To explore the application value of enhanced recovery after surgery (ERAS) in colorectal cancer patients.Methods:From January 2017 to December 2018, 60 patients with colorectal cancer who admitted to the Second People′s Hospital of Lianyungang were selected and divided into ERAS group and control group according to the random digital table method, with 30 patients in each group.The inflammation, nutritional indicators, immune indicators and clinical manifestations before and after surgery in the two groups were compared.Results:At 1 d and 3 d after surgery, the C-reactive protein (CRP) levels in the ERAS group were (70.2±10.3)mg/L, (82.5±8.2)mg/L, respectively, which were lower than those in the control group [(81.5±9.9)mg/L, (110.2±12.9)mg/L] ( t=4.324, 9.911, all P<0.05). On the third day after operation, the levels of albumin and prealbumin in the ERAS group were (31.6±4.8)g/L, (196.8±40.6)g/L, respectively, which were higher than those in the control group [(28.0±5.8)g/L, (172.1±38.8)g/L]( t=2.621, 2.409, all P<0.05). The immune parameters(IgA, IgM, IgG, CD 4+, CD 4+ /CD 8+) in the ERAS group were higher than those in the control group( t=2.132, 2.223, 6.063, 4.253, 2.828, all P<0.05). The number of cases with thirsty and hunger on the day of surgery in the ERAS group was 3 cases and 7 cases, respectively, which were less than 21 cases and 25 cases of the control group(χ 2=22.500, 21.696, all P<0.05). The first exhaust time, defecation time and hospital stay time in the ERAS group were (36.2±12.1)h, (63.4±13.4)h and (9.5±3.2)d, respectively, which were shorter than those in the control group [(54.7±13.8)h, (96.5±18.8)h and (12.1±4.0)d] ( t=5.513, 7.845, 2.761, all P<0.05). The incidence of complications between the two groups had no statistically significant difference ( P>0.05). Conclusion:ERAS can significantly reduce the physical and psychological traumatic stress of patients with colorectal cancer, achieve rapid recovery, improve the treatment effect, shorten the length of hospital stay, reduce social and family burden, and provide a basis for the choice of clinical treatment program.

Objective:To investigate the efficacy and safety of comprehensive therapy in the treatment of advanced unresectable hepatocellular carcinoma.Methods:Clinical data of 34 patients with primary liver cancer admitted to Peking Union Medical College Hospital from Nov 2018 to Dec 2020 initially evaluated as unresectable were treated firstly by combined therapy and then underwent reevaluation for further management.Results:A total of 34 patients completed the integrative treatment, and no serious adverse events occurred. Among them, 6 patients were evaluated as partial remission, and underwent successful tumor resection, tumors in 7 patients were stable, and 21 patients suffered from disease progression.Conclusion:After comprehensive therapy, unresectable tumors in some patients could reduce and be rendered resection.

Objective To investigate the value of optical trocar insertion technique in establishing pneumoperitoneum in patients undergoing laparoscopic surgery after previous abdominal surgery. Methods A total of 29 patients, with a history of abdominal surgery, who planned to undergo laparoscopic liver surgery were enrolled and randomly divided into optical trocar insertion group and open approach group. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of ranked data between groups. Results There were no procedure-related complications in either group. Compared with the open approach group, the optical trocar insertion group had a significantly shorter time required to establish pneumoperitoneum [35.00 (21.00-46.00) seconds vs 180.00 (152.50-252.50) seconds, U =0, P < 0.001] and a significantly smaller incision length [1.10(1.00-1.20) cm vs 2.80(2.45-3.00) cm, U =0, P < 0.001]. Conclusion Both optical trocar insertion and open approach for establishing pneumoperitoneum is relatively safe in patients undergoing laparoscopic liver surgery after previous abdominal surgery, while optical trocar insertion has the advantages of high efficiency and minimal invasiveness in establishing pneumoperitoneum.