Objective:To evaluate the short-term efficacy of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early-stage gastric cancer.Methods:This is a retrospective case series study. Data of 17 consecutive early gastric cancer patients from a prospective cohort at Beijing Friendship Hospital,Capital Medical University were analyzed between August 2023 and August 2024. Sixteen cases were from the department of general surgery and 1 from the department of gastroenterology. The cohort included 9 males and 8 females,with a mean age of 61.4 years (range: 46 to 79 years). Clinical data,including demographics,pathological features,surgical procedures,and follow-up outcomes,were collected through medical records and databases. All patients were followed for over 3 months,with follow-up ending on December 5,2024.Results:A total of 17 patients were involved. Among them, 5 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node dissection (LSBD),and another 3 patients who underwent complete ESD resection received LSBD due to pathological stage meeting the expanded indications. 6 patients who underwent non-curative ESD resection received laparoscopic gastric regional resection (LRG) combined with LSBD,and another 3 patients directly received LRG combined with LSBD. The average number of sentinel lymph nodes dissected before surgery ( M(IQR)) was 8.9 (4.5) (range: 4 to 21),and the detection rate and accuracy rate were both 100%. Postoperative pathology confirmed that there was no metastasis in the sentinel lymph nodes of 5 patients who underwent ESD combined with LSBD and 3 patients who underwent LSBD after complete ESD resection. The vertical and horizontal margins of ESD were all negative. One patient was an absolute indication for ESD. For the 6 patients who underwent non-curative ESD resection combined with LRG and LSBD,the horizontal margins were all negative. Two patients showed 1 metastasis in each of the 21 and 9 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed during the operation. Postoperatively,73 and 39 lymph nodes were retrieved respectively. The former had 1 additional metastasis,while the latter had no metastasis. Among the 3 patients who underwent direct LRG combined with LSBD,the horizontal margins were negative. One patient was confirmed as an absolute indication for ESD by postoperative pathology,and one patient had 1 metastasis in 8 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed. Postoperatively,there was no metastasis in 54 lymph nodes. All patients had no complications such as infection,bleeding,perforation,or death after surgery. Among the 14 patients who did not receive additional radical surgery,they were able to pass gas and defecate within 3 days after surgery,with an average hospital stay of 6 days. The nutritional indicators and gastric radionuclide emptying imaging half-emptying time were similar to those before surgery at 3 months after surgery. Conclusions:Laparoscopic and endoscopic cooperative regional gastrectomy with sentinel lymph node basin dissection has the advantages of minimal invasiveness,preservation of gastric function,and precise treatment. It maybe suitable for patients with early-stage gastric cancer at high risk of lymph node metastasis and has good short-term efficacy.

Objective:To investigate the impact of ubiquitin-specific protease 38 (USP38) on the proliferation and migration of gastric cancer cells.Methods:Between March and September 2023, tissue samples were collected from 18 patients who underwent radical gastrectomy in the Department of General Surgery, Beijing Friendship Hospital Affiliated to Capital Medical University, and had complete clinical data. The samples included tumor tissue, adjacent tumor tissue, and normal tissue. Among the patients, there were 12 males and 6 females, aged between 34 and 71 years, with an average age of 62.5 years. The expression levels of USP38 in different tissue samples were validated using quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). The functional significance of USP38 was verified through cell experiments and human tissue samples by knocking down or exogenously overexpressing USP38. Potential molecular mechanisms of USP38 were validated through qRT-PCR, MTT, Transwell, Western blot, mass spectrometry, clone formation assays, and immunoprecipitation. Measurement data with a normal distribution are expressed as the mean±standard deviation ( ± s). Comparisons between groups were performed using a t-test or one-way analysis of variance. Measurement data with a skewed distribution were described as [ M( Q1, Q3)], and comparisons between groups were performed using non-parametric tests. Comparisons between counting data were performed using the chi-squared test or Fisher′s exact probability method, with P<0.05 indicating a statistically significant difference. Results:qRT-PCR confirmed that USP38 was highly expressed in gastric cancer tissues compared to normal and paratumor tissues. Furthermore, mass spectrometry analysis identified FASN as a potential downstream target of USP38, and immunoprecipitation experiments demonstrated a positive correlation between its expression level and USP38. USP38 was highly expressed in the SGC7901, AGS, and HGC27 gastric cancer cell lines. Knockdown of USP38 reduced FASN expression, thereby inhibiting cell proliferation and migration abilities. While the ability of cell proliferation and migration was increased significantly.Conclusions:USP38 is highly expressed in gastric cancer cells and promotes their proliferation and migration, potentially through downstream FASN-mediated fatty acid synthesis.

Objective:To investigate the perioperative safety, short-term and long-term efficacy, and surgical strategy of laparoscopic partial gastrectomy for gastrointestinal stromal tumors at the esophagogastric junction.Methods:Seventy-eight patients with mesenchymal tumors in the esophagogastric junction were retrospectively enrolled from September 2018 to August 2023 in which the upper edge of the tumor is less than 2 cm from the Z-line or has invaded the Z-line <1/2 circumference. There were 31 males (39.7%) and 47 females (60.3%), with an average age of (57.2±11.8) years and an average body mass index of (24.5±3.5) kg/m 2. All cases were divided into the wedge resection (WR) group ( n=51) and the resection by opening all of the layers of the stomach wall (RASW) group ( n=27) according to the surgical methods. Surgical outcomes, complications, recover and postoperative gastroesophageal reflux of both groups were compared. The measurement data with a normal distribution were represented by mean±standard deviation ( ± s), and values were compared using the independent sample t-test. The measurement data with a skewed distribution were represented by median (interquartile range) [ M( Q1, Q3)], and values were compared using the Mann-Whitney U test. Count data were expressed as examples (percentages) [ n(%)], and the χ2 test was used to compare countable data. A non-parametric test was used to compare the grade data. Results:The WR group had shorter operation time [(97.1±32.6) min vs (149.9±54.9) min, t=-5.33, P<0.001], less intraoperative blood loss [15(10, 20) mL vs 20(10, 50) mL, z=-2.47, P=0.014], shorter postoperative exhaust time [2(1, 3) d vs 3(2, 3) d, z=-2.49, P=0.013], shorter postoperative oral intake time [2(2, 3) d vs 4(2, 5) d, t=-3.70, P<0.001], shorter postoperative semi-liquid diet time[5(4, 6) d vs 7(5, 8) d, z=-3.57, P<0.001], and shorter postoperative hospital stay [5(4, 6) d vs 7(6, 8) d, z=-4.16, P<0.001] than the RASW group, with statistically significant differences. There was no significant difference in short-term (≤30 days) complications between the two groups (2.0% vs 3.7%, z=-0.46, P=0.648). No cases of cardia stenosis occurred in either group. In the WR group, 3 patients developed gastroesophageal reflux at 6 months postoperatively, with 2 patients relieved after taking acid-suppressing drugs and 1 patient not completely relieved. In the RASW group, 1 patient developed gastroesophageal reflux at 6 months postoperatively and was not completely relieved after taking acid-suppressing drugs. No other patients had gastroesophageal reflux. No other patients have gastroesophageal reflux. Conclusions:WR and RASW are safe and feasible for mesenchymal tumors at the esophagogastric junction in which the upper edge of the tumor is less than 2 cm from the Z-line or has invaded the Z-line <1/2 circumference, and has achieved an excellent short-term effect. The choice of surgical approach can be determined based on varions factors such as the location of the tumor, the relationship of the position between the tumor and the cardia, and whether the tumor is exophytic growth.

Objective:To explore the perioperative safety and postoperative efficacy of prophylactic jejunal nutrition tube placement during early gastric body cancer pylorus-preserving gastrectomy (PPG).Methods:The clinical data of 29 gastric cancer patients treated by Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2024 were retrospectively analyzed. There were 17 males (58.6%) and 12 females (41.4%), aged from 43 to 74 years, with an average age of (58.9 ± 8.3) years, and an average body mass index (BMI) of (24.3 ± 3.0) kg/m 2. According to the type of catheterization, all cases were divided into jejunal nutrition tube group ( n=12) and gastric tube group( n=17). The main outcome was the incidence of delayed gastric emptying within one month after surgery in both groups. Statistical analysis was conducted using SPSS26.0 software. Results:Patients in the jejunal feeding tube group resumed oral liquid intake, soft diet and regular diet significantly earlier postoperatively compared to those in the gastric tube group, with statistically significant differences ( P<0.05). Conversely, the time to removal of the tube was significantly earlier in the gastric tube group than in the jejunal feeding tube group ( P<0.05). However, the proportion of patients requiring reinsertion of a gastric or jejunal feeding tube postoperatively was significantly higher in the gastric tube group (7 cases) compared to the jejunal feeding tube group (0 case) ( P<0.05). In the jejunal feeding tube group, there were 4 cases occurred DGE, in the gastric tube group, there were 8 cases occurred DGE. There were no statistically significant differences between the two groups in either the overall incidence of DGE or the distribution of DGE severity grades. On postoperative 7th day , the Gastric Outlet Obstruction Scoring System (GOOSS) grade was significantly better in the jejunal feeding tube group than in the gastric tube group ( P<0.05), and all patients in the jejunal feeding tube group had resumed liquid intake, compared to only 58.8% in the gastric tube group. Conclusions:Compared with gastric tube placement, intraoperative prophylactic jejunal feeding tube placement for PPG has significant advantages in perioperative safety and postoperative recovery, but large-sample prospective studies are still needed for further verification.

Objective:To evaluate the short-term efficacy of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early-stage gastric cancer.Methods:This is a retrospective case series study. Data of 17 consecutive early gastric cancer patients from a prospective cohort at Beijing Friendship Hospital,Capital Medical University were analyzed between August 2023 and August 2024. Sixteen cases were from the department of general surgery and 1 from the department of gastroenterology. The cohort included 9 males and 8 females,with a mean age of 61.4 years (range: 46 to 79 years). Clinical data,including demographics,pathological features,surgical procedures,and follow-up outcomes,were collected through medical records and databases. All patients were followed for over 3 months,with follow-up ending on December 5,2024.Results:A total of 17 patients were involved. Among them, 5 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node dissection (LSBD),and another 3 patients who underwent complete ESD resection received LSBD due to pathological stage meeting the expanded indications. 6 patients who underwent non-curative ESD resection received laparoscopic gastric regional resection (LRG) combined with LSBD,and another 3 patients directly received LRG combined with LSBD. The average number of sentinel lymph nodes dissected before surgery ( M(IQR)) was 8.9 (4.5) (range: 4 to 21),and the detection rate and accuracy rate were both 100%. Postoperative pathology confirmed that there was no metastasis in the sentinel lymph nodes of 5 patients who underwent ESD combined with LSBD and 3 patients who underwent LSBD after complete ESD resection. The vertical and horizontal margins of ESD were all negative. One patient was an absolute indication for ESD. For the 6 patients who underwent non-curative ESD resection combined with LRG and LSBD,the horizontal margins were all negative. Two patients showed 1 metastasis in each of the 21 and 9 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed during the operation. Postoperatively,73 and 39 lymph nodes were retrieved respectively. The former had 1 additional metastasis,while the latter had no metastasis. Among the 3 patients who underwent direct LRG combined with LSBD,the horizontal margins were negative. One patient was confirmed as an absolute indication for ESD by postoperative pathology,and one patient had 1 metastasis in 8 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed. Postoperatively,there was no metastasis in 54 lymph nodes. All patients had no complications such as infection,bleeding,perforation,or death after surgery. Among the 14 patients who did not receive additional radical surgery,they were able to pass gas and defecate within 3 days after surgery,with an average hospital stay of 6 days. The nutritional indicators and gastric radionuclide emptying imaging half-emptying time were similar to those before surgery at 3 months after surgery. Conclusions:Laparoscopic and endoscopic cooperative regional gastrectomy with sentinel lymph node basin dissection has the advantages of minimal invasiveness,preservation of gastric function,and precise treatment. It maybe suitable for patients with early-stage gastric cancer at high risk of lymph node metastasis and has good short-term efficacy.

Objective:To explore the perioperative safety and postoperative short-and long-term efficacy of stomach-partitioning gastrojejunostomy (SPGJ) with distal selective vagotomy (DSV) for treating benign gastric outlet obstruction (GOO).Methods:The clinical data of 26 benign GOO patients treated by Beijing Friendship Hospital, Capital Medical University from January 2019 to July 2023 were retrospectively analyzed. There were 20 males (76.9%) and 6 females (23.1%), aged from 25 to 75 years, with an average age of (55.8±13.6) years, and an average body mass index (BMI) of (20.1±3.4) kg/m 2. There were 12 cases in SPGJ-DSV group and 14 cases in SPGJ group. The main outcome was the gastrointestinal quality of life index (GIQLI) 1 year after surgery in both groups. Independent sample t-test was used to test the difference between the continuous variables with normal distribution. The comparison between groups of non-normal distribution continuous variables was tested by Mann-Whitney U test. Counting data were compared using Chi-square test or Fisher exact test. Results:There were no significant differences between the two groups in terms of operative time ( P=0.071), intraoperative blood loss ( P=0.422), time to pass gas ( P=0.538), time to liquid intake ( P=0.386), postoperative hospitalization ( P=0.431), complications within 30 days after surgery ( P=0.999), and postoperative GOOSS grade ( P=0.483). Among them, postoperative DGE occurred in one patient in each of the two groups, both of which were grade A. In the follow-up results, compared with the SPGJ group, SPGJ-DSV group had a significant advantage in GIQLI score, and the difference was statistically significant ( P=0.028). The incidence of gastric ulcer, reflux esophagitis, bile reflux and gastritis in SPGJ-DSV group was 8.3%, 8.3%, 8.3% and 58.3%, while that in SPGJ group was 35.7%, 21.4%, 21.4% and 57.1%, respectively, but there was no statistical significance between groups. Conclusion:In the treatment of benign GOO patients, SPGJ with DSV did not significantly increase the difficulty of laparoscopic procedures, operative time and intraoperative blood loss. Moreover, it showed a significant advantage in gastrointestinal quality of life 1 year after surgery. In addition, the incidence rates of gastric ulcers and reflux esophagitis were lower in the SPGJ-DSV group 1 year after surgery, but further confirmation is needed in large sample studies.

Objective:To compare the clinical efficacy between robot-assisted and free-hand percutaneous cannulated screwing (PCS) in the treatment of femoral neck fractures in the middle-aged and young patients.Methods:A retrospective study was conducted to analyze the clinical data of 53 patients with femoral neck fracture who had been treated with PCS from May 2020 to May 2022 at Department of Traumatic Surgery, Maoming Hospital Affiliated to Southern Medical University. In the robot group of 25 patients subjected to robot-assisted PCS, there were 11 males and 14 females with an age of (48.2 ± 11.9) years; in the free-hand group of 28 patients subjected to free-hand PCS, there were 13 males and 15 females with an age of (48.5 ± 9.8) years. The 2 groups were compared in terms of operation time, intraoperative bleeding, intraoperative guide drills, intraoperative fluoroscopy frequency, fracture union time, Harris hip score at the last follow-up and postoperative complications. Postoperative imaging examination was performed to evaluate distribution accuracy of the cannulated screws in the femoral neck (deviation between the screws and the femoral neck axis, parallelism between the screws and distance between the screws and the neck cortex).Results:There was no statistically significant difference between the robot and free-hand groups in the general clinical data before operation, showing comparability ( P>0.05). The robot group showed significantly shorter operation time [(32.7 ± 4.8) min], significantly less intraoperative bleeding [(14.6 ± 4.8) mL], significantly less intraoperative guide drillings [(3.5 ± 0.7) times] and significantly less intraoperative fluoroscopy frequency [(7.9 ± 1.4) times] than the free-hand group [(56.9 ± 11.3) min, (27.0 ± 7.3) mL, (9.1 ± 1.8) times and (16.3 ± 6.0) times)] (all P<0.05). Postoperative imaging showed that the deviation between the screws and the femoral neck axis was 4.4° ± 1.1° on the anteroposterior X-ray film and 3.2° ± 0.8° on the lateral X-ray film, the parallelism between the screws 4.9° ± 0.8° on the anteroposterior X-ray film and 3.0° ± 0.7° on the lateral X-ray film, and the distance between the screws and the femoral neck cortex (10.4 ± 2.7) mm in the robot group, all significantly smaller than those in the free-hand group [10.5° ± 2.8°, 4.9° ± 1.1°, 12.1° ± 4.0°, 5.1° ± 1.3°, and (15.4 ± 3.2) mm] (all P<0.05). All the 53 patients were followed up for (22.2 ± 8.5) months. All fractures got united. The fracture union time in the robot group [(20.6 ± 4.6) weeks] was insignificantly shorter than that in the free-hand group [(23.7 ± 7.7) weeks] ( P>0.05). At the last follow-up, the Harris hip score in the robot group [(88.6 ± 5.6) points] was significantly higher than that in the free-hand group [(84.8 ± 6.3) points] ( P<0.05). Follow-ups revealed 2 cases of internal fixation loosening, 1 case of screw head cutting and 1 case of femoral head necrosis in the free-hand group but none of such complications in the robot group. Conclusion:In the treatment of femoral neck fractures in the middle-aged and young patients, compared with free-hand PCS, robot-assisted PCS shows advantages of shorter intraoperative time, less bleeding, less fluoroscopic radiation, higher accuracy of screw placement, a lower incidence of postoperative complications and better functional recovery of the hip joint.

There are four types of hiatal hernia, among which type Ⅰ sliding hernia is the most common and its incidence increases with age. At present, domestic and foreign scholars tend to treat hiatal hernia by surgery, but for this kind of functional surgery, both curative effect and neural protection are needed, so higher requirements are put forward for operators. Therefore, it is necessary for clinicians to master the vagus neuroanatomy and its relationship with the peripheral vascular system and identify the necessity of preserving vagus nerve, so as to provide a basis for accurate treatment of hiatal hernia. Therefore, this article reviews the protection and anatomy of vagus nerve in hiatal hernia during the operation.

In recent years, the incidence of esophagogastric junction adenocarcinoma (AEG) has gradually increased. At present, radical surgery is still the most effective treatment for early AEG, and its surgical methods include proximal gastrectomy and total gastrectomy. Although proximal gastrectomy preserves part of the structure and function of the stomach, postoperative complications such as gastroesophageal reflux seriously affect the quality of life of patients. Although total gastrectomy reduces the incidence of complications such as gastroesophageal reflux, the surgical trauma is large, and the postoperative digestive function is severely reduced, leading to complications such as anemia. As the prognosis of early gastric cancer is good, how to choose the gastrointestinal reconstruction method and improve the patient′s postoperative quality of life has gradually become the focus of the surgeon′s attention. The postoperative quality of life of different digestive tract reconstruction methods for early esophagogastric junction adenocarcinoma is reviewed.

Objective To investigate the efficacy and adverse reactions of azithromycin sequential therapy for the treatment of children with mycoplasma pneumonia.Methods 84 children with mycoplasma pneumonia were randomly divided into study group and control group according to the digital table,with 42 cases in each group.The study group was given azithromycin treatment,and the control group was given erythromycin treatment.The clinical curative effect and adverse reaction were compared between the two groups.Results The total effective rate of the study group (97.62％) was significantly higher than that of the control group (76.19％),and the difference was statistically significant (x2 =11.95,P ＜ 0.05).The pyretolysis time [(3.78 ± 1.57) d],cough improvement time [(3.29 ± 0.74) d],rate disappearance time[(5.88 ± 2.35) d],average hospitalization time [(8.89 ± 1.76) d] of the study group were significantly shorter than those of the control group [(4.49 ± 1.71) d,(4.28 ± 0.77) d,(7.69 ±2.54) d,(10.05 ± 2.27) d],and the differences were statistically significant (t =2.01,6.33,3.29,2.46,all P ＜0.05).The incidence rate of adverse reactions such as nausea,abdominal distention,abdominal discomfort,local injection pain,rash,elevated alanine aminotransferase of the study group (4.76％) was significantly lower than that of the control group (19.05％),and the difference was statistically significant (x2 =4.86,P ＜ 0.05).Conclusion Azithromycin sequential therapy is effective in the treatment of children with mycoplasma pneumonia.It can effectively shorten the disappearance time of clinical symptoms and signs,and average hospitalization time,and has low incidence rate of adverse reactions.It is worthy of clinical use.