Laparoscopic curative gastrectomy has been widely adopted because it is minimal invasiveness.The efficacy of laparoscopic gastrectomy is comparable to that of open gastrectomy for patients with early or advanced gastric cancer,but few studies of laparoscopic total gastrectomy combined with distal pancreatectomy and splenectomy for patients with advanced gastric cancer have been reported.Seven patients with advanced gastric cancer received laparoscopic total gastrectomy combined with distal pancreatectomy and splenectomy at the First Hospital of Jilin University from September 2010 to September 2011.The mean operation time,blood loss,postoperative hospital stay and the nunber of lymph nodes resected were (218 ± 24) minutes,(366 ± 174) ml,( 14.6 ± 2.8 ) days and 32 ± 15,respectively.Two patients were complicated by pancreatic juice leakage and were cured with drainage. No anastomotic leakage,abdominal bleeding or mortality was observed. With the development of techniques and equipments,laparoscopic total gastrectony combined with distal pancreatectomy and splenectomy is safe and feasible in selected patients.

BACKGROUND:The limitations of computer technology in the study of bone biomechanics and the prediction of bone fixation strength, stability, fatigue damage and life expectancy are more difficult. OBJECTIVE:To investigate the new progress and application of finite element analysis in orthopedics. METHODS:The first author searched PubMed (http://www.ncbi.nlm.nih.gov/PubMed) and CNKI China journal ful-text database (http://www.cnki.net/) published til November 2015. Key words were“finite element analysis, orthopedics, biomechanics”. There were 51 references in English and 320 Chinese literatures. According to the inclusion criteria, 40 literatures were selected. RESULTS AND CONCLUSION:Biomechanics of human skeleton is very complex, and most of the mechanical state is a locomotive, non-static process, thus increasing the difficulty of orthopedic biomechanics research. The prediction concerning bone fixation strength, stability, fatigue damage and lifetime is more difficult. However, the finite element analysis technology, which has been widely applied and demonstrated its reliability actual y in engineering fields, can solve these problems effectively. With the rapid development of computer technology, finite element analysis in the field of orthopedic applications has increasingly been used, which also promoted the development of orthopedic technology.

Objective To analyze therapeutic effect of savolitinib in patients with stage Ⅲ/Ⅳ non-small cell lung cancer (NSCLC). Methods A total of 95 patients with MET 14 exon (METex14) jumping mutation in stage Ⅲ/Ⅳ NSCLC were divided into a control group (47 cases) and an observation group (48 cases) through a random-number table method. The patients in the control group were treated with crizotinib, whereas those in the observation group were treated with savolitinib. The clinical efficacy and incidence of toxic side effects in both groups were evaluated through a chi-square test, and survival was evaluated through Kaplan-Meier survival analysis. Results Compared with control group (31.91% and 70.21%), the objective response rate and disease control rate of the observation group were 52.08% and 87.50%, respectively (P<0.05). According to Kaplan-Meier survival analysis, the overall survival and progression free survival rates in the observation group were higher than those in the control group (Log rank χ²=8.003, 4.528; P=0.005, 0.033). No statistically significant difference in the degree of toxic side effects was found between the groups (P>0.05). Conclusion Savolitinib can improve the efficacy of treatment for stage Ⅲ/Ⅳ METex14 skip mutation NSCLC patients, prolong survival, enhance the tolerance of patients to savolitinib, and facilitate the management of adverse reactions.

Objective To comprehensively measure the burden of hepatitis B, liver cirrhosis and liver cancer in Shandong province, using disability-adjusted life years (DALYs) to estimate the disease burden attribute to hepatitis B virus (HBV)infection. Methods Based on the mortality data of hepatitis B, liver cirrhosis and liver cancer derived from the third National Sampling Retrospective Survey for Causes of Death during 2004 and 2005, the incidence data of hepatitis B and the prevalence and the disability weights of liver cancer gained from the Shandong Cancer Prevalence Sampling Survey in 2007, we calculated the years of life lost (YLLs), years lived with disability (YLDs) and DALYs of three diseases following the procedures developed for the global burden of disease (GBD) study to ensure the comparability. Results The total burden for hepatitis B, liver cirrhosis and liver cancer were 211 616 (39 377 YLLs and 172 239 YLDs), 16 783 (13 497 YLLs and 3286 YLDs) and 247 795 (240 236 YLLs and 7559 YLDs) DALYs in 2005 respectively, and men were 2.19, 2.36 and 3.16 times as that for women, respectively in Shandong province. The burden for hepatitis B was mainly because of disability (81.39%). However, most burden on liver cirrhosis and liver cancer were due to premature death (80.42% and 96.95%). The burden of each patient related to hepatitis B, liver cirrhosis and liver cancer were 4.8, 13.73 and 11.11 respectively. Conclusion Hepatitis B, liver cirrhosis and liver cancer caused considerable burden to the people living in Shandong province, indicating that the control of hepatitis B virus infection would bring huge potential benefits.

Objective To observe the effect of three-step sequential therapy on the pathomorphology of the bronchial lung tissues of rat asthmatic model with airway remodeling after hormone intervention using light microscope and electron microscope.Methods The airway remodeling of asthmatic rats model was induced by hormone intervention to simulate hormone withdrawal (HW)of steroid dependent asthma (SDA)patients.Altogether 150 rats randomly divided into five groups (each n =30)of airway remode-ling group,dexamethasone intervention group,pulmicort group,three-step sequential therapy group and normal control group.Morphological changes of the bronchial lung tissues of rats of all groups were ob-served under light microscope and electron microscope,and thicknesses of the bronchial walls and the bronchial smooth muscle and the number of the cell nucleus in the bronchial smooth muscle were meas-ured.Results Using HE staining,the lung tissues of rats except for those in normal control group were infiltrated by inflammation cells with different degrees,but the rats of three-step sequential therapy group were observed significantly slight inflammatory reaction.Using Masson trichromatic staining,massive col-lagen fiber in pulmonary interstitial of airway remodeling group deposited,while deposition increased dur-ing hormone withdrawal in dexamethasone intervention group,and significantly less deposition was ob-served in both three-step sequential therapy group and pulmicort group.Before HW,the thickness of the bronchial walls in three-step sequential therapy group decreased significantly compared with that in airway remodeling group(P <0.01);during and after HW,the thickness of the bronchial walls in three-step se-quential therapy group decreased compared with dexamethasone intervention group and airway remodeling group(P <0.01,P <0.05).Before HW,there is no difference (P >0.05)of bronchial smooth muscle thickness observed in all the medication groups;during and after HW,bronchial smooth muscle thickness decreased compared with dexamethasone intervention group and airway remodeling group(P <0.01,P <0.05).The number of cell nucleus in the bronchial smooth muscle of three-step sequential therapy group decreased significantly,regardless of HW,compared with dexamethasone intervention group and airway remodeling group(P <0.01).Using electron microscope,airway epithelial cilia falling off was remark-ably alleviated during HW in three-step sequential therapy group and pulmicort group,while that in dexa-methasone intervention group during or after HW was the same as the airway remodeling group. Conclusion Three-step sequential therapy could inhibit the airway remodeling by the way of relieving inflammatory changes of the bronchial lung pathomorphology of rat asthmatic model.

Since the International guidelines for groin hernia management were published in 2018,many new evidences have been published.In October 2023,the HerniaSurge Group published Update of the international HerniaSurge guidelines for groin hernia management.It updated eight chapters of the last guidelines,proposed 20 key questions,and 39 new statements and 32 recommendations,of which 16 were strong recommendations.This article combined clinical concerns to sort out and interpret the updated version.

Objective:To investigate the value of generative adversarial networks-based PET image reconstruction in improving the quality of low-dose 18F-FDG PET images and lesion detection in pediatric patients. Methods:Retrospective analysis of 61 PET images of children (38 males, 23 females, age (4.0±3.5) years) who underwent 18F-FDG total-body PET/CT imaging in Beijing Friendship Hospital, Capital Medical University from August 2021 to December 2021 was performed. The low-dose images (30 s, 20 s, 10 s) of all children extracted by list mode were input into the generative adversarial networks for deep learning (DL) reconstruction to obtain the corresponding simulated standard full-dose images (DL-30 s, DL-20 s, DL-10 s). The semi-quantitative parameters of the liver blood pool and primary lesion of standard full-dose 120 s, 30 s, 20 s, 10 s, DL-30 s, DL-20 s, and DL-10 s images were measured. The target-to-background ratio (TBR), contrast-to-noise ratio (CNR), and CV were calculated. The 5-point Likert scale was used for subjective scoring of image quality, and the detective abilities for positive lesions of each groups were compared. The sensitivities and positive predictive values of positive lesions detection were calculated. Mann-Whitney U test and Kruskal-Wallis rank sum test and χ2 test were used for data analyses. Results:CNR of the 30 s, 20 s, and 10 s groups were lower than those of DL-30 s, DL-20 s, and DL-10 s groups, respectively ( z values: -3.58, -3.20, -3.65, all P<0.05). Score of DL-10 s group was significantly lower than those of 120 s, DL-30 s and DL-20 s groups (4(3, 4), 5(4, 5), 4(4, 5), 4(4, 5); H=97.70, P<0.001). There were no significant differences in TBR, CNR, CV, SUV max and SUV mean of lesions and liver blood pool in 120 s, DL-30 s, DL-20 s, and DL-10 s groups ( H values: 0.00-6.76, all P>0.05). The sensitivities of positive lesion detection in DL-30 s, DL-20 s, and DL-10 s groups were 97.83%(225/230), 96.96%(223/230), 95.65%(220/230), respectively, and the positive predictive values were 96.57%(225/233), 93.70%(223/238), 84.94%(220/259), respectively. The positive predictive value in DL-10 s group was lower than those in DL-30 s and DL-20 s groups ( χ2=23.51, P<0.001). There were more false-positive and false-negative lesions detected by DL-10 s group than those of DL-30 s and DL-20 s groups in different sites. Conclusion:Based on the generative adversarial networks, the image quality of DL-20 s group is high and can meet the clinical diagnostic requirements.

Objective:To compare the aortic remodeling of the Fabulous stent system and standard thoracic aortic endovascular repair (TEVAR) on distal aorta type B aortic dissection (TBAD). Methods:The prospective data collected between Dec 2017 and Oct 2019 from 134 patients with type B aortic dissection (TBAD) who underwent treatment with the "Fabulous" stent system, and retrospective data from 159 TBAD patients receiving standard TEVAR from corresponding multicenter. By using propensity score matching analysis, we compared the prognosis and aortic remodeling outcomes in patients undergoing Fabulous and standard TEVAR treatments during a 1-year postoperative follow-up.Results:In this study, 62 patients in Fabulous group and 62 patients in standard TEVAR were included.There were no significant statistical differences in baseline characteristics between the two groups. In terms of aortic remodeling in bare stent region, Fabulous group had better change trends of diameter of true lumen [10.6 (4.4, 14.5) mm vs. 4.7 (0.9, 10.7) mm, P=0.001] and false lumen [-24.2 (-30.5, -4.9) mm vs. 0.7 (-11.8, 2.3) mm, P<0.001] than those in the standard TEVAR group. The rate of complete false lumen thrombosis was also higher in the Fabulous group (62.9% vs. 37.1%, P=0.042). Conclusion:The Fabulous stent system, when compared to standard TEVAR surgery, demonstrates good aortic remodeling outcomes in the distal aorta.