Gastric cancer with peritoneal metastasis (GCPM) is a common and lethal manifestation of advanced gastric cancer, with a median survival of only 5-11 months. This consensus was developed by 30 experts from Asia (China, Japan, Korea, and Singapore) using the Delphi method and the GRADE evidence grading system. A total of 29 statements were formulated, covering the diagnosis and assessment of GCPM, indications for laparoscopic exploration and NIPS (normothermic intraperitoneal and systemic treatment), treatment regimens, prevention and management of complications, criteria for conversion surgery, and postoperative intraperitoneal therapy. The consensus aims to standardize clinical practice and improve the prognosis of patients with GCPM.

Objective:To evaluate the feasibility of a predictire model composed of non-specific test indexes in early diagnosis of gastric cancer.Methods:From the database of electronic medical record system of Shanghai Changhai Hospital, a total of 24 615 case records were included from January 1, 2010 to April 30, 2019, including 10 497 cases of gastric cancer, 5 198 cases of precancerous diseases, and 8 920 cases of health examination. Through stratified random sampling, the study population was divided into validation set, training set and test set. After data processing and quality control for all laboratory variables, the optimal machine learning algorithm and diagnostic efficiency grouping were selected through four machine learning algorithms, induding the gradient boosting decision tree, random forest, support vector machine, and artificial neural network, and the data were trained by backward stepwise regression method to build the best feature model.Result:In this study, a diagnostic model V22 consisting of 22 routine testing parameters was established. V22 could distinguish early gastric cancer from control group composed of healthy group and precancerous disease, AUC was 0.808, the sensitivity was 85.7%, and the specificity was 91.9%. For CEA negative gastric cancer, V22 also showed high diagnostic accuracy, AUC was 0.801.Conclusion:V22 was a valuable model for the diagnosis of gastric cancer. V22 was an auxiliary diagnostic model of gastric cancer with clinical application value, which could well distinguish early gastric cancer from the control group composed of healthy group and precancerous disease, and the detection rate of early gastric cancer was better than the traditional tumor marker CEA.

The Hedgehog (HH) signaling pathway plays important roles in gastrointestinal carcinogenesis and the gastrointestinal tumor microenvironment (TME). Aberrant HH signaling activation may accelerate the growth of gastrointestinal tumors and lead to tumor immune tolerance and drug resistance. The interaction between HH signaling and the TME is intimately involved in these processes, for example, tumor growth, tumor immune tolerance, inflammation, and drug resistance. Evidence indicates that inflammatory factors in the TME, such as interleukin 6 (IL-6) and interferon-

Objective To explore the current status of physician-nurse collaboration in public Class Ⅲ general hospitals and analyze its related factors so as to provide a basis and data support for pushing forward physician-nurse collaboration and improving negatively related factors. Methods From April to June 2018, totals of 465 nurses and 249 physicians form 6 public ClassⅢ general hospitals in Beijing were selected as subjects by convenience sampling and cross-sectional study. The questionnaire survey was carried out with the Chinese version of Nurse-Physician Collaboration Scale(NPCS). The related factors of physician-nurse collaboration were analyzed with the simple correlation and multiple linear regression. Results The scores of NPCS of 465 nurses and 249 physicians were(78.81±17.68)and(84.86±15.22)respectively. Simple correlation showed that there were statistical differences in the scores of NPCS among physicians and nurses with the different personnel categories,physician-nurse working relationships,physician-nurse working mode, whether to carry out clinical pathways or not and income satisfaction(P< 0.05). Multiple linear regression revealed that the related factors of physician-nurse collaboration included the physician-nurse working mode, personnel categories,income satisfaction and clinical pathways with statistical differences(P < 0.05). Conclusions Public Class Ⅲ general hospitals have good physician-nurse collaboration. However,physicians and nurses lack communication in participating the treatment and nursing decision making for patients. Managers should further deepen the reform of personnel system,implement position management and performance incentive systems,carry out the physician and nurse responsibility system and physician-nurse working mode and positively develop clinical pathways so as to promote physician-nurse collaboration.

Objective To study the effects of TGFβ-activated kinase-1 (TAK1)mediated cell autophagy after global cerebral ischemia-reperfusion (IR ) in rats.Methods Seventy-two male Kunming rats were randomly divided into six groups:control group (group C),sham operation group (group S),ischemia-reperfusion group (group IR),TAK1 shRNA lentivirus group (group T),nega-tive lentivirus group (group Y)and normal saline group (group NS)(n = 12 each).The rats in groups T,Y and NS received cerebral ventricles injection of TAK1 shRNA lentivirus,negative lenti-virus and normal saline 10 μl two weeks before preparing animal model.Using thread embolism of the right middle cerebral artery occlusion (MCAO)to cause focal ischemia for 2 h and released for 24 h for reperfusion in groups IR,T,Y and NS.The common carotid arteries were separated but not liga-ted in group S,the rest of the procedure as the same as group IR.The rats of each group were evalua-ted by neurological severity scores (NSS)24 h after reperfusion,the cerebral infarct volume was measured with the method of TTC and the expression of TAK1,LC3Ⅱ/LC3Ⅰ,Beclin1 and p62 pro-tein in rat hippocampus were determined by using Western blot.Results The infarct volume and NSS in groups IR,T,Y and NS were significantly higher than those in group C (P <0.05).The infarct volume and NSS in group T were significantly lower than those in group IR (P <0.05).TAK1 pro-tein of hippocampus in groups IR,Y and NS was significantly higher than that in group C (P <0.05).TAK1 protein of hippocampus in group T were significantly lower than that in group IR (P <0.05).LC3Ⅱ/LC3 Ⅰand Beclin1 protein of hippocampus in groups IR,T,Y and NS were signifi-cantly higher than those in group C,and the p62 protein of hippocampus in groups IR,T,Y and NS was significantly lower than that in group C (P <0.05).The LC3 Ⅱ/LC3 Ⅰand Beclin1 in group T were significantly lower than those in group IR,and the p62 protein of hippocampus in group T was significantly higher than that in group C (P < 0.05 ).Conclusion TAK1 mediated cell autophagy takes part in the mechanism of brain ischemia-reperfusion injury in rats.

Objective To compare the bispectral index score ( BIS) correlationbetween standard frontal sensor position and an alternative zygomatic position under general anesthesia with propofol combined with remifentanil during neurosurgery. Methods Twenty patients undergoing neurosurgery were enrolled. Everyone received total intravenous anesthesia by target-controlled infusion of propofol and remifentanil. Two BISTM Quatro sensors mounted on the frontal and zygomatic regions were connected to BIS VistaTM monitors on each patient during general anesthesia.Data from each position were collected and analyzed at the time of awakening ( t1 ) , intubation ( t2 ) , incision ( t3 ) , the end of surgery ( t4 ) , and extubation ( t5 ) . Results At t1 , zygomatic BIS(88.95±6.42) was significantly lower than frontal BIS (84.85±9.64,P<0.01).But during anesthesia,different of BIS value was no statistical significance between the standard frontal position and an alternative zygomatic position(P>0.05). Scatter plot analysis revealed a significant correlation between BIS of frontal positionand that of zygomatic position( R2=0.892,P=0.000) . Conclusion During the anesthesia maintenance period,the zygomatic position can be availably used as an alternative position for monitoring if the operative field renders the standard frontal position unavailable.

Objective To investigate the application value of surgical treatments for severe traumatic hepatorrhexis patients. Methods Clinical data of 25 patients with severe traumatic hepatorrhexis receiving surgical treatments in Changhai Hospital of Second Military Medical University from October 2009 to October 2013 were retrospectively analyzed. There were 17 males and 8 females with the average age of (35±10) years. According to the injury scale of American Association for the Surgery of Trauma, 17 cases were divided as grade Ⅳ, 5 as grade Ⅴ and 3 as grade Ⅵ. The informed consents of all patients were obtained and the local ethical committee approval had been received. Full preparation was made prior to surgery. All patients underwent emergency surgery under general anesthesia via intubation. Twenty patients received irregular hepatectomy, 1 underwent regular hepatectomy, 3 received repair of retrohepatic inferior vena cava under total hepatic vascular exclusion and 1 was treated with perihepatic gauze packing. Results Twenty-three cases were cured, and 2 died from hemorrhagic shock. Six cases developed postoperative complications including 3 with subphrenic abscess, 1 with biliary leakage, 1 with pleural effusion and 1 with wound infection. All were cured after symptomatic treatments. Conclusions Surgical hemostasis should be performed immediately for patients with severe traumatic hepatorrhexis. Irregular hepatectomy is the primary surgical procedure.

Objective To explorer the safety of D2 lymphadenectomy in open distal gastrectomy for distal gastric cancer with the surgical approach from bottom to top,from left to right and from surrounding to middle.Methods 100 advanced distal gastric cancer patients selected from General Surgery Department of Chang Hai Hospital from December 2012 to November 2013 were analyzed retrospectively.All the patients were performed D2 lymphadenectomy in open distal gastrectomy with surgical approach from bottom to top,from left to right and from surrounding to middle.The operation time,amount of bleeding,the number of lymph nodes,postoperative complications and follow-up observation were recorded.Ruselts All patients had successful operation.The operation time was 90 to 190 mins,the average (125.00 ± 21.43) mins;intraoperative blood was 90 to 400 ml,the average (178.00 ± 73.74) ml;number of lymph node dissection was 17 to 41,the average (26.00 ± 6.72).One patient suffered from abdominal hemorrhage,recoverd and discharged after conservative treatment.Conclusions Surgical approach from bottom to top,from left to right and from surrounding to middle can improve the safety of D2 lymphadenectomy for distal gastric cancer.

OBJECTIVE To explore the role of runt-related transcription factor 3(RUNX3) in the tumorgenesis and progression of cervical carcinoma. METHODS The immunohistochemical staining technique was used to detect the expression of RUNX3 protein in 25 cases of normal cervix, 34 intraepithelia neoplasia (CIN), and 48 cervical carcinomas. SYBR Green I chimeric fluorescence Real-time PCR was applied to detect the expression of RUNX3 mRNA in 10 cases of normal cervix, 24 CIN, and 30 cervical carcinomas. RESULTS The expressions of RUNX3 protein and mRNA in normal cervix, CINI,CINII-III, and cervical carcinoma tissues tended to be down-regulated. There was significant difference among these groups (P<0.05). The expressions of RUNX3 protein and mRNA in the cervical carcinoma tissues were correlated with the histological differentiation, clinical stage, and lymphatic metastasis (P<0.05), but had no relationship with the age, high-risk human papillomavirus infection, and histological classification (P> 0.05). CONCLUSION RUNX3 may function as a tumor suppressor gene in the occurrence and progression of cervical carcinoma.
Adult ; Carcinoma, Squamous Cell ; genetics ; metabolism ; Cervical Intraepithelial Neoplasia ; genetics ; metabolism ; Core Binding Factor Alpha 3 Subunit ; genetics ; metabolism ; Disease Progression ; Female ; Humans ; Middle Aged ; RNA, Messenger ; genetics ; metabolism ; Uterine Cervical Neoplasms ; genetics ; metabolism

One of the core tasks assigned to clinical teachers is to enable students to accurately assign a diagnostic label.The strengths and weaknesses of different approaches to clinical reasoning will be examined using one of the core divides between various models of analytic versus non-analytic as an orienting framework.Clinical teachers should stress the importance of both forms of reasoning,thereby enabling students to marshal reasoning processes in a flexible and context-specific manner.