Gastric cancer is one of the most common malignant tumors of the digestive tract globally, causing a heavy burden on society due to its high incidence and mortality rates. Patients with gastric cancer and peritoneal metastasis suffer poor prognosis, and peritoneal metastasis is a major factor in the recurrence and metastasis of gastric cancer. Currently, the diagnosis of peritoneal metastasis mainly relies on contrast-enhanced CT, PET-CT, and other imaging techniques, but these technologies have a limited capability to detect small lesion of peritoneal metastases. Laparoscopic exploration is still considered as the most reliable method to diagnose peritoneal metastasis of gastric cancer. It allows direct visualization of the abdominal cavity and peritoneal regions, facilitating the detection of metastases. Furthermore, it enables the collection of histological or cytological specimens for definitive pathological diagnosis. However, the area formed by the parietal peritoneum and visceral peritoneum is large and has many folds in space. To explore the tumor and peritoneum as comprehensively as possible, our team has proposed the "Four-Step Procedure" of laparoscopic exploration for gastric cancer to standardize the operation process of laparoscopic exploration, which is characterized by its safety, comprehensiveness, precision and ease of implementation. This article primarily discusses the limitation of routine clinical techniques in diagnosing peritoneal metastasis in gastric cancer and introduce the significant value of the "Four-Step Procedure" in diagnosing peritoneal metastasis in gastric cancer.

Gastric cancer is one of the most common malignant tumors of the digestive tract globally, causing a heavy burden on society due to its high incidence and mortality rates. Patients with gastric cancer and peritoneal metastasis suffer poor prognosis, and peritoneal metastasis is a major factor in the recurrence and metastasis of gastric cancer. Currently, the diagnosis of peritoneal metastasis mainly relies on contrast-enhanced CT, PET-CT, and other imaging techniques, but these technologies have a limited capability to detect small lesion of peritoneal metastases. Laparoscopic exploration is still considered as the most reliable method to diagnose peritoneal metastasis of gastric cancer. It allows direct visualization of the abdominal cavity and peritoneal regions, facilitating the detection of metastases. Furthermore, it enables the collection of histological or cytological specimens for definitive pathological diagnosis. However, the area formed by the parietal peritoneum and visceral peritoneum is large and has many folds in space. To explore the tumor and peritoneum as comprehensively as possible, our team has proposed the "Four-Step Procedure" of laparoscopic exploration for gastric cancer to standardize the operation process of laparoscopic exploration, which is characterized by its safety, comprehensiveness, precision and ease of implementation. This article primarily discusses the limitation of routine clinical techniques in diagnosing peritoneal metastasis in gastric cancer and introduce the significant value of the "Four-Step Procedure" in diagnosing peritoneal metastasis in gastric cancer.

Objective:To study the expression of stomatin-like protein 2(STOML2)in oral squamous cell carcinoma(OSCC)tissue and the effects of STOML2 on the tumorigenicity of OSCC cells(OSCCCs)in vitro and in vivo,and the related mechanism.Methods:The protein expression of STOML2 in OSCC and adjacent tissues of 56 patients was detected.OSCCCs SCC-15 were divided into 2 groups.Stom12-siRNA plasmid was transfected into the cells of experimental group and Mock-siRNA plasmid was transfected into the cells of control group.The mRNA and protein expression of STOML2,CDK4 and P16 in the cells was detected by qPCR and Western blot respectively.The cell cycle of the cells was detected by flow cytometry,and the proliferation of the cells was detected by CCK8 asay.The tumorigenicity of the cells was detected by subcutaneous tumor model in nude mice.Results:The positive rate of STOML2 in OSCC and adjacent tissues was 92.86％(52/56)and 8.93％(5/56)respectively(P＜0.001).After siRNA transfection,STOML2 mRNA expression in SCC-15 cells of experimental group and control group was(0.43±0.09)and(1.23±0.19),STOML2 protein ex-pression was(0.52±0.11)and(0.94±0.17)respectively.CDK4 expression was(0.33±0.13)and(1.18±0.17),P16 expression was(0.93±0.12)and(0.29±0.03),respectively.In CCK8 assay the absorbance of SCC-15 cells in experimental group and control group was(1.11±0.24)and(2.19±0.28),in flow cytometry the percentage of cells in G2/M phase was 35.72％±5.33％and 18.65％±3.71％(P＜0.05),respectively.In vivo test showed that the volume(μm3)of subcutaneous transplanted tumor was 1 192.07 ±250.9 and 2 280.5±600.1,the weight(g)of mice was 0.65±0.30 and 1.62±0.40,respectively.Conclusion:STOML2 expression increases in OSCC,STOML2 affects the tumorigenic ability of OSCCCs in vitro and in vivo by regulating P16 related pathways.

Objective:To explore the clinical efficacy of immunoadsorption in highly sensitized kidney transplant (KT) candidates.Methods:From September 2019 to April 2023, the relevant clinical data were retrospectively reviewed for 26 highly sensitized KT recipients. Protein A immunoadsorption desensitization therapy was offered after KT. The effect of immunosorbent on reducing anti-human leukocyte antigen (HLA) antibodies was summarized. And operative success rate and postoperative complication incidence were calculated.Results:The mean number of treatment session was (10.76±5.53). The highest level of HLA-Ⅰ antibody mean fluorescence intensity (MFI) dropped from (17 921±4 442) to (7 333±6 434) with a decline of 59% and HLA-Ⅱ antibody MFI decreased from (21 135±5 245) to (10 989±7 627) with a decline of 48%. The differences were statistically significant (both P<0.001). All kidneys were harvested from cadavers. The complications were acute antibody mediated rejection (7 cases), perioperative pulmonary infection (3 cases) and myelosuppression (2 cases). The average follow-up period was (30.8±12.6) month. The graft survival rate was 88.5% (23/26) and the recipient survival rate 100% (26/26) . Conclusions:Immunoadsorption therapy can effectively reduce HLA antibody in highly sensitized KT candidates, thereby increasing the probability of successful KT. In terms of safety, immunosorbent therapy may boost the potential risks of infection and myelosuppression. It requires heightened attention.

Surgical resection is one of the important means to achieve long-term survival for patients with liver malignant tumor. However, most of the liver malignant tumor has been diagnosed in the middle and late stage, and lose the chance of surgical treatment. For these patients who have lost the chance of surgery, some surgeons have proposed the concept of planned liver resection, which is to reduce tumor stage and increase future liver remnant (FLR) in a planned way, so as to improve the safety of surgery and prolong the survival time of patients after surgery. For patients with FLR insufficiency after prior evaluation or/and treatment, the technique of hepatic hyperplasia is an important part of planned hepatectomy, that is, to effectively increase FLR in a short period of time by various means. Portal vein ligation (PVL) and portal vein embolization (PVE), associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are three main techniques for hepatic hyperplasia. This article reviews the principle, effect and safety of three liver augmentation techniques.

Malignant obstructive jaundice is caused by direct invasion or compression of the biliary tract by malignant tumors of the bile duct, pancreas and other systems. Patients are often accompanied by symptoms such as malnutrition, low immune function, and organ damage. The treatments of active preoperative biliary drainage and reasonable reinfusion combined with enteral nutrition can help improve the safety of patients during the perioperative period, reduce postoperative complications, and improve the life quality of patients. This article reviewed the research progress of preoperative biliary drainage, bile recycling methods and precautions in patients with malignant obstructive jaundice, aiming to provide reference for clinical diagnosis and treatment practice.

Objective:To review the paper on the admittance evaluation indicators of palliative care for patients with heart failure, and clarify the admittance evaluation indicators of palliative care for patients with heart failure and corresponding evaluation criteria or tools at home and abroad.Methods:Based on the framework of the scoping review, paper retrieval was carried out through computer in PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), WanFang Database, Chinese Biomedical Literature Database and VIP. The retrieval time limit was from the establishment of the database to April 30, 2022. The original research and review on the admittance evaluation of palliative care for patients with heart failure were included, and the data were independently screened and extracted by two researchers.Results:A total of 15 papers were included. The results of document integration showed that the admittance evaluation indicators of palliative care for patients with heart failure included four categories, namely, disease progress, patient needs, medical resource utilization and medical institutions. It included 12 evaluation indicators and corresponding evaluation criteria or evaluation tools, including the patient's expected survival period, cardiac function, high-risk biomarkers, exercise status, complications, advanced treatment, patient's subjective will, complex symptom relief needs, social support needs, multiple unplanned admissions, hospital stay extension, and medical institution software and hardware resources.Conclusions:The content of the admittance evaluation indicators of palliative care for patients with heart failure is comprehensive, but the evaluation criteria for some indicators are not clear, and there is no consensus on the whole. In the future, researchers can select sensitive evaluation indicators on the basis of existing research, construct the admittance evaluation indicators of palliative care for patients with heart failure, and verify it in clinical practice, so as to promote the application of palliative care in the disease management of patients with heart failure.

Lung cancer is the most common cancer and the leading cause of cancer-related death in China. Early screening of lung cancer proves to be effective in improving its prognosis. The National Comprehensive Cancer Network (NCCN) has updated and released version 2, 2022 NCCN clinical practice guidelines for lung cancer screening in July, 2022. Based on high-quality clinical evidence and the latest research progress, the guidelines have developed and updated criteria for lung cancer screening which have been widely recognized by clinicians around the world. Compared with Chinese lung cancer screening guidelines, this article will interpret the updated content of the brand new 2022 NCCN screening guidelines, providing some reference for the current lung cancer screening practice in our country.

Objective To investigate the effect of different concentrations of Echinococcus multilocularis secretion antigen (Em-sAg) on the phenotype and function of mouse bone marrow-derived dendritic cells (BMDCs) induced by lipopolysaccharide (LPS). Methods The bone marrow precursor cells isolated from the mouse bone marrow cavity were stimulated by mouse recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF) to form BMDCs, and then cell morphology was observed under an inverted microscope. After the purity of BMDCs was identified by flow cytometry, BMDCs were divided into control group, positive control group (LPS 1 μg/ml), LPS+3 mg/ml Em-sAg group, LPS+1.5 mg/ml Em-sAg group, LPS+0.75 mg/ml Em-sAg group, and LPS+0.375 mg/ml Em-sAg group. Flow cytometry was used to measure the expression of BMDC surface molecules (CD80, CD86, and MHC-Ⅱ molecules) in each group, and ELISA was used to measure the expression level of the cytokine IL-12p70. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t -test was used for further comparison between two groups. Results Observation under an inverted microscope showed that after 8-10 days of culture, the cells had burr-like protrusions and were in a state of complete suspension. Flow cytometry showed that the positive rate of CD11c was above 70% and most of the cultured cells were identified as BMDCs based on this. Flow cytometry further showed that compared with the control group, the LPS group had significant increases in the cell molecules CD80, CD86, and MHC-Ⅱ on surface (all P < 0.05); compared with the LPS group, the LPS+3 mg/ml Em-sAg group, the LPS+1.5 mg/ml Em-sAg group, the LPS+0.75 mg/ml Em-sAg group, and the LPS+0.375 mg/ml Em-sAg group had a significant reduction in CD80 ( F =34.870, P < 0.001), while there were no significant reductions in CD86 and MHC-Ⅱ( P > 0.05). ELISA showed that there was a significant difference in the level of IL-12 p70 between groups ( F =73.140, P < 0.05); compared with the control group, the LPS group had a significant increase in the expression level of IL-12p70 after stimulation ( P < 0.05); compared with the positive control group, the LPS+3 mg/ml Em-sAg group, the LPS+1.5 mg/ml Em-sAg group, the LPS+0.75 mg/ml Em-sAg group, and the LPS+0.375 mg/ml Em-sAg group had a significant reduction in the expression level of IL-12p70 ( P < 0.05), and the degree of reduction in the pro-inflammatory factor IL-12p70 increased with the increase in the concentration of Em-sAg. Conclusion Different concentrations of Em-sAg can inhibit LPS-induced maturity of BMDCs and the expression of the pro-inflammatory cytokine IL-12p70.

Objective:To evaluate the application effect of palliative care based on multidisciplinary cooperation in patients with heart failure.Methods:Randomized controlled trials of palliative care in patients with heart failure were searched by computer in PubMed, Embase, CINAHL, The Cochrane Library, China Biology Medicine disc, CNKI, Wanfang Database, VIP and other Chinese and English databases. The search time limit was from the establishment of the databases to December 31, 2020. Two researchers independently screened the literature, extracted the data and evaluated the quality. RevMan 5.4 software was used to conduct a meta-analysis of the included studies.Results:A total of 12 studies were included, including 1 402 patients. Meta-analysis results showed that compared with conventional management, palliative care based on multidisciplinary collaboration could improve quality of life of patients with heart failure ( SMD=0.72, 95% CI: 0.32-1.11, P<0.01), reduce the burden of symptoms on patients ( MD= -12.90, 95% CI: -20.25--5.54, P<0.01), and reduce depression level ( MD=-0.38, 95% CI: -3.69--0.08, P<0.05), anxiety level ( MD=-0.35, 95% CI: -0.66--0.05, P<0.05) and rehospitalization rate of patients ( RR=0.70, 95% CI: 0.57-0.86, P<0.01). There was no statistically significant difference in mortality between patients ( RR=1.02, 95% CI: 0.63-1.63, P=0.94) . Conclusions:Palliative care based on multidisciplinary collaboration can improve the quality of life of patients with heart failure, reduce the burden of symptoms, depression level and anxiety level and reduce the rehospitalization rate of patients, but it has no significant effect on reducing the mortality rate of patients. Given that palliative care is still in its infancy in China and is limited by the quality and quantity of included studies, the above conclusions need to be verified by more large-sample and high-quality studies.