Objective To assess the evolving disease burden of esophageal and gastric cancers in China from 1990 to 2021, with a focus on gender disparities, and construct a predictive model to forecast disease trends from 2022 to 2031, aiming to optimize targeted prevention strategies. Methods Epidemiological data for esophageal and gastric cancers in China (1990-2021) were extracted from the Global Burden of Disease (GBD) 2021 database. Temporal trends were analyzed using Joinpoint regression (version 4.9.1.0), and future trends were predicted via the GM (1, 1) model under grey system theory. Results From 1990 to 2021, tobacco- and alcohol-attributable burdens of esophageal cancer increased, while tobacco- and diet-related burdens of gastric cancer showed no significant change. Deaths and disability-adjusted life years (DALY) for esophageal cancer rose by 40.61% and 17.89%, respectively; gastric cancer deaths increased by 18.95%, though DALY decreased by 1.22%. Both cancers exhibited significant declines in age-standardized mortality rates (−45.78% for esophageal cancer, −53.29% for gastric cancer) and age-standardized DALY rates (−51.45% for esophageal cancer, −57.58% for gastric cancer). China’s age-standardized mortality and DALY rates for both cancers remained consistently higher than global averages. Males exhibited disproportionately higher burdens than females. Predictive modeling projected continued but decelerating declines in disease burdens for both cancers by 2031. Conclusion Over three decades, China achieves measurable reductions in esophageal and gastric cancer burdens, though gastric cancer burdens remain higher than esophageal cancer. Persistent disparities relative to global levels, elevated male burdens, and aging demographics highlight the urgency for prioritized interventions targeting high-risk populations.

Background::Response to immune checkpoint inhibitors (ICIs) is affected by multiple factors. This study aimed to explore whether sites of metastasis are associated with clinical outcomes of ICIs in advanced non-small-cell lung cancer (NSCLC) patients.Methods::The data of NSCLC patients with high programmed death-ligand 1 expression and good performance status receiving first-line ICIs monotherapy from Guangdong Provincial People’s Hospital between May 2019 and July 2020 were retrospectively analyzed. Metastatic sites included liver, bone, brain, adrenal gland, pleura, and contralateral lung. Progression-free survival (PFS) and overall survival (OS) were compared between different metastatic sites and metastatic burden by the Kaplan-Meier method. Organ-specific disease control rate (OSDCR) of different individual metastatic sites was evaluated.Results::Forty NSCLC patients meeting the criteria were identified. The presence of liver metastasis was significantly associated with shorter PFS (3.1 vs. 15.5 months, P = 0.0005) and OS (11.1 months vs. not reached, P = 0.0016). Besides, patients with bone metastasis tend to get shorter PFS (4.2 vs. 15.5 months, P = 0.0532) rather than OS ( P = 0.6086). Moreover, the application of local treatment could numerically prolong PFS in patients with brain metastasis (15.5 vs. 4.3 months, P = 0.1894). More metastatic organs involved were associated with inferior PFS ( P = 0.0052) but not OS ( P = 0.0791). The presence of liver metastasis or bone metastasis was associated with more metastatic organs (Phi[φ]: 0.516, P = 0.001). The highest OSDCR was observed in lung (15/17), and the lowest in the liver (1/4). Conclusions::Metastases in different anatomical locations may be associated with different clinical outcomes and local tumor response to ICIs in NSCLC. ICIs monotherapy shows limited efficacy in patients with liver and bone metastasis, thus patients with this type of metastasis might require more aggressive combination strategies.

Objective:To compare the outcomes of combined lingual mucosal graft with buccal mucosal graft urethroplasty and combined lingual mucosal graft with ADM (acellular dermal matrix) urethroplasty for the treatment of repair failed hypospadias.Methods:From February 2017 to February 2019, 26 patients with failed hypospadias repairs were treated with combined lingual mucosal graft with buccal mucosal graft urethroplasty (14 cases in Group A), and combined lingual mucosal graft with ADM urethroplasty (12 cases in Group B). The mean age of Group A was (29.5±1.2) years (range 18.0-41.0 years), and (26.5±0.8) years (range 20.0-38.0 years) in Group B. The previous operation times was mean (3.6±0.7)(range 2-5 times) and (4.6±0.8)(range 3-5 times) in Group A and Group B respectively. Operation method: All patients were nasally intubated, the remaining curvature was corrected, the fibrous tissue or scar was removed, and the defected urethra was measured. In Group A, the lingual mucosa was spread and fixed to the corpora cavernosa over the midline as the urethral plate, the buccal mucosa was covered the lingual mucosa as ventral urethra, both the mucosa lateral edges was sutured. In Group B, the lingual mucosa was harvested and fixed to the corpora cavernosa the same as in Group A, the ADM was made appropriate length and width, covered and sutured with the lingual mucosa. The lingual mucosa was harvested mean (5.0±0.2)cm(range 4-6cm)long, mean (1.2±0.2)cm (range 1.0-1.5cm)wide and mean (5.0±0.2)cm(range 5-6cm)long, mean (1.2±0.2)cm (range 1.0-1.5cm)wide in Group A and Group B respectively( P<0.05). In Group A, the buccal mucosa was harvested mean (4.1±0.2)cm(range 3.5-5.5cm)long, mean (1.2±0.2)cm wide. Criteria for successful repair of hypospadias were set as: ①The appearance of the penis is nearly normal; ②The penis curvature was corrected; ③Urethra orifice in normal position; ④Urine flow line is normal. The outcomes of the two groups were analyzed and compared, statistical analysis was done using SPSS 18.0 software. Results:The mean follow-up time was (16.3±1.6)(8-24) months. The age, number of preoperative surgeries, number of previous oral mucous membranes, and length of urethral defects were no statistically significant differences between the two groups in A and B( P>0.05). The length of oral mucosa was harvested during the operation between group A and Group B were statistically significant differences( P<0.05). The incidence of oral complications in group A and B: Oral pain 7/14, 1/12; The feeling of tension in mouth 8/14, 1/12; The numbness in the oral 8/14, 1/12, A and Group B were statistically significant differences( P<0.05). The incidence of urethral complications in group A and Group B: the urethra fistula 1/14, 4/12; the urethral stricture 2/14, 6/12, there were statistically significant differences between the two groups ( P<0.05). Penile curvature 2/14, 1/12, ( P>0.05). The success rate was 12/14 and 5/12 in Group A and B respectively, with statistical difference( P<0.05). Conclusions:Combined lingual mucosal graft with buccal mucosal graft urethroplasty could be a good choice for repeated failed hypospadias repairs. Combined lingual mucosal graft with ADM urethroplasty has many complications and less success, should be performed in caution.

Objective To analyze the donor site complications of male patients with long segment anterior urethral strictures that underwent urethroplasty by using a long-strip lingual mucosal grafts (LMG) six months later.Methods Between August 2006 and December 2014,a total of 81 patients with long segment anterior urethral stricture underwent a procedure of urethroplasty using a long-strip LMG.The mean patients' age was 41.2 years (range 18-74) and the mean urethral stricture length was 12.1 cm (range,8-20 cm),a single LMG was more than 9 cm.Two techniques of urethroplasty were performed:One-sided dorsal graft augmentation urethroplasty was performed in 70 patients,12 of the 70 patients underwent urethroplasty by using a LMG in addition to a BMG,owing to the presence of very long strictures;Dorsal patch graft urethroplasty was performed in 11 patients.Results Of the 81 patients a single long-strip LMG with length of 9-11 cm was used in 52 patients,LMG measured ≥12 cm in 17,and LMG combined with buccal mucosal graft (BMG) in 12.The mean follow-up period was 41 months (range,15-86 months) postoperatively.The overall urethroplasty success rate was 82.7％.Six months after the operation,28 patients (34.6％) reported a minimal to moderate difficulty in fine motor movement of the tongue (difficulty with spitting tiny fish bones).Among these 28,22 patients (27.2 ％) had associated numbness over the donor site,10 patients (12.3％) had parageusia,and 11 patients (13.6％) reported slurring of speech.The donor site complications occurred higher in patients with LMG length ≥ 12 cm (14/29) than those patients with LMG length ＜ 12 cm (14/52)(x2 =19.049,P ＜0.01).At 12 months,5 patients (6.2％)reported minimal difficulty in fine motor movement of the tongue,and reduced to 1 patient at 24 months.Conclusions The donor side complications after long-strip lingual mucosal graft for the treatment of longsegment anterior urethral strictures are primarily limited to the first postoperative year,the incidence of complications appeared to be related to the length of the harvested graft.

Objective To explore the appropriate management for girls with posttraumatic urethral stricture or loss secondary to pelvic fracture.Methods Between January 2009 and December 2015,a total of 20 girls,mean age of 9.5 years (range 2-14 years),whose posttraumatic urethral stricture associated with urethrovaginal fistula were treated using a variety of procedures.The mean urethral stricture or loss length was 2.6 cm (range 2-4 cm).Six patients presented with vaginal distal stricture and associated with a large hydrocolpos in the proximal vagina.Of the 20 girls,urethroplasty was performed using labial pedicle flap or vulvar flap in l0 patients,using a bladder flap tube in 5 girls with total urethral loss,using vaginal flap in 5 cases.Colpoplasty using island vulvar skin flaps or hydrocolpos vagina were performed in the 6 patients associated with vaginal stricture during urethroplasty.Results There were no serious complications postoperatively.The mean follow-up period was 41 months (range 12-70 months) postoperatively.The overall anatomical success rate was 90％ (18/20) and the functional success rate was 70％ (14 / 20).Of 10 patients underwent pedicle labial or an island flap of vulva urethroplasty,2 patients were recurrent,and 2 patients present stress incontinence.Five patients underwent urethral reconstruction using a bladder flap tube and voiding well postoperatively,of which stress incontinence appeared in 2.All 5 patients who underwent vaginal flap urethroplasty could void normally and continently.The hydrocolpos disappeared in all 6 patients with vaginal distal severe stricture.Conclusions A differential surgical repair strategy should be determined by fistula location,stricture length and vaginal condition for posttraumatic urethral stricture associated with urethrovaginal fistula in girls.It is probably good choice to reconstruct distal urethra and vagina using a large hydrocolpos in the proximal vagina for the treatment of coexisting strictures of urethra and vagina.

ObjectiveTo evaluate the efficacy of using oral mucosal grafts (buccal mucosa and lingual mucosa) for urethroplasty in the treatment of anterior urethral strictures. Methods Between Jan 2001 and Dec 2010,255 patients with urethral strictures (length ranging from 3 cm to 18 cm,mean 6 cm)underwent one-stage onlay oral mucosal grafts urethroplasty.Two different techniques were used for urethral reconstruction.The first technique involved tubularized dorsal lingual mucosa graft (LMG) augmentation of urethral plate ; the second technique used dorsal patch graft urethroplasty.Of the 255 patients,49 patients with long-segment urethral strictures ( ≥ 8 cm) underwent dual buccal mucosal graft ( BMG),dual LMG,combined LMG and BMG or long-strip LMG urethroplasty. ResultsThe patients were followed up for 8 -120 months postoperatively ( mean 37 months).Of the 255 cases,230 cases voided well and the urinary peak flows ranged from 16 to 51 ml/s (mean 26 ml/s).The overall success rate was 90.2％.Seventeen cases developed a recurrence of urethral stricture.Among these patients,15 underwent BMG urethroplasty again and 2 underwent direct vision internal urethrotomy,after which the patients voided well.Eight cases presented with urethrocutaneous fistula,these patients underwent a second operation,after which,the urethrocutaneous fistulas were cured. Conclusions The buccal mucosa and lingual mucosa are excellent sources of graft materials for the repair of anterior urethral strictures.Combined two oral mucosal grafts substitution urethroplasty is an effective technique for the treatment of long-segment urethral strictures.