Objective:To investigate the application value of biological muscle flap in laparo-scopic radical proximal gastrectomy with esophagogastric anastomosis.Methods:The retrospec-tive and descriptive study was conducted. The clinicopathological data of 10 patients with adeno-carcinoma of esophagogastric junction who were admitted to The First Affiliated Hospital of Xi′an Jiaotong University from May 2023 to August 2023 were collected. All patients were males, aged (65±5)years. All patients underwent laparoscopic radical proximal gastrectomy and esophagogastric anastomosis with digestive tract reconstruction using the esophagogastric biological muscle flap. Observation indicators: (1) surgical situations and early complications; (2) follow-up and late com-plications. Measurement data with normal distribution were represented as Mean± SD, and measure-ment data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations and early complications. All 10 patients success-fully completed the surgery without conversion to open surgery, and the operation time was (166±18)minutes. Cases with digestive tract reconstruction as end-to-side anastomosis and Overlap anas-tomosis were 1 and 9, respectively. The time of digestive tract reconstruction, the number of lymph node dissected, volume of intraoperative blood loss, time to postoperative first anal exhaust, time to postoperative first intake of liquid food, duration of postoperative hospital stay were (40±12)minutes, 24±6, (41±9)mL, (3.4±0.5)days, (4.1±1.0)days, (8.3±0.7)days in the 10 patients. Of 4 cases with postoperative early complications, 1 case developed pulmonary infection (Clavien-Dindo grade Ⅱ) on the second day after surgery, with pulmonary infection absorbed after 5 days of antibiotic treat-ment. Two cases experienced chest distress and shortness of breath on the third day after surgery, with the diagnosis of a small to moderate amount of pleural effusion after chest B-ultrasound examination. After pleural puncture and active treatment, the symptoms of them were improved and the pleural effusion disappeared. There was 1 case with choking sensation when eating solid food, which was started from the third week after surgery. Upper gastrointestinal imaging revealed mild anastomotic stenosis of Clavien-Dindo grade Ⅰ in the patient, who was improved after conservative treatment. On the 7th day after surgery, all 10 patients underwent upper gastrointestinal angiography, and no anastomotic leakage or stenosis occurred. There was no sign of contrast agent reflux in the supine position and 30° head down position. (2) Follow-up and late complications. All 10 patients were followed up for 59.5(range, 31.0-127.0)days. The esophageal reflux scale score of 10 patients was 1.4±0.3. During the follow-up, 1 case underwent gastroscopy on 40 days after surgery, which showed reflux esophagitis with Los Angeles grade as B and the Clavien-Dindo grade as Ⅰ. There was no clinical symptom such as heartburn or acid reflux. Results of 24-hour pH monitoring showed that the patient experienced 24 instances of reflux in an upright position and 15 instances of reflux in a supine position, with no prolonged reflux. The total reflux time within 24 hours was 75 minutes. The DeMeester score was 38.3. Results of esophageal pressure measurement showed that the esophageal contraction morphology was normal, but the anastomotic opening was not well relaxed. The rest of 9 cases had no complication such as reflux esophagitis.Conclusion:Biological muscle flap applied in the laparoscopic radical proximal gastrectomy with esophagogastric anastomosis is safe and feasible, with satisfied short-term efficacy.

Laparoscopic proximal gastrectomy (LPG) can be selected for the treatment of early upper gastric carcinoma, but gastroesophageal reflux after operation would seriously affect the quality of life of patients. Esophagogastric anastomosis with double flap technique is a digestive tract reconstruction method using the anastomosis between the esophagus and the anterior wall of the stomach. Compared with other digestive tract reconstruction methods, esophagogastric anastomosis with double flap technique can maintain the postoperative body mass of patients in good condition, improve the nutritional status and the long-term quality of life of patients. Esophagogastric anasto-mosis with double flap technique has good anti reflux effects and retain the possibility of endoscopic examination and treatment. By reviewing literatures at home and abroad, and combined with clinical experiences, the authors discuss current status and digestive tract reconstruction methods of LPG, and deeply investigate the application prospect of esophagogastric anastomosis with double flap technique.

【Objective】 To investigate the predictive value of visceral fat area （VFA） in patients with gastric cancer after radical gastrectomy. 【Methods】 A retrospective analysis was performed on 195 patients who underwent radical gastrectomy in the Department of General Surgery， The First Affiliated Hospital of Xi’an Jiaotong University from January 2014 to December 2017. CT image data and clinicopathological data within 1 week before surgery were collected. VFA was calculated by software， and the patients were divided into VFA-H group （n=96） and VFA-L group （n=99）. The relationship between VFA in different groups and long-term prognosis was compared. 【Results】 CT examination results showed that VFA value was （111±62） cm²， and BMI was positively correlated with VFA value （r=0.640， P<0.001）. ROC curve showed that VFA was more valuable in predicting the prognosis of gastric cancer （AUC=0.703， P<0.001） and better than BMI. Cox regression analysis of prognostic factors in gastric cancer patients： Univariate analysis showed that age， tumor length， TNM stage and VFA were the influencing factors for prognosis， while multivariate analysis showed that TNM stage III and VFA-L were independent risk factors for prognosis of gastric cancer patients. 【Conclusion】 VFA has a good predictive ability and can be used to evaluate the prognosis of gastric cancer patients after operation.

【Objective】 To confirm whether the preoperative fibrinogen to pre-albumin ratio (FPR) is a prognostic factor for patients with gastric adenocarcinoma and to analyze the relationship between FPR and clinicopathological characteristics of gastric adenocarcinoma patients. 【Methods】 We retrospectively reviewed the clinical data of 404 patients with gastric cancer who received radical gastrectomy in the Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, from January 2012 to December 2016. We analyzed the preoperative FPR’s effects on the prognosis of patients with gastric cancer and the relationship between FPR and the clinicopathological variables. 【Results】 The optimal cut-off point of FPR obtained by ROC curve analysis was 15.0, and gastric cancer patients were divided into low FPR group (<15.0) and high FPR group (≥15.0). The univariate Cox regression analysis showed that age, preoperative anemia, tumor size, histological grade, TNM stage, and preoperative FPR were risk factors for the prognosis of gastric cancer (P<0.05). The multivariate Cox regression analysis showed that TNM stage and preoperative FPR were independent prognostic factors for gastric cancer (P<0.05). The subgroup analysis results indicated that the prognosis of patients in the low FPR group was better than that in the high FPR group of patients with stage Ⅰ-Ⅱ and stage Ⅲ gastric cancer (P<0.05). Further analysis showed that compared with those in the high FPR group, patients in the low FPR group had an older age, a larger proportion of males, a lower rate of anemia before surgery, smaller tumor diameter, and earlier TNM staging (P<0.05). 【Conclusion】 The preoperative FPR is an independent prognostic factor for gastric cancer. This study provides a clinical basis for its application in predicting the long-term prognosis of patients with gastric cancer.

Objective To investigate the role of metastatic lymph node ratio (MLR) in the evaluation of prognosis of patients with gastric cancer (GC) at different lymph node numbers examined.Methods Clinical data were reviewed retrospectively in a total 535 patients who underwent surgery for GC.Spearman correlation analysis between MLR or number of metastatic lymph nodes (N) and examined lymph node numbers,Kaplan-Meier method was used for comparison survival rates of N stage and MLR stage.A receiver operating characteristic (ROC) curve was used to evaluate the role of N stage and MLR stage in the prognosis of GC patients.Results Metastatic lymph node ratio and number of metastatic lymph nodes correlated with the examined lymph node numbers (r =0.146,r =0.378,P ＜ 0.01,P ＜ 0.001).The 5 year survival rate of MLR0,MLR1,MLR2 and MLR3 patients were 57.5％,69.9％,40.0％ and 21.7％ respectively when examined lymph node numbers ＜ 6 (P ＜ 0.01).The 5-YSR of MLR0,MLR1,MLR2 and MLR3 patients were 86.8％,59.2％,35.8％ and 39.2％ respectively when between 6-10 (P ＜0.001) and the 5-YSR of MLR0,MLR1,MLR2 and MLR3 patients were 88.7％,62.5％,0 and 17.7％ respectively when they ＞ 10(P ＜0.001).AUC of MLR staging was 0.68 ±0.05 when the numbers ＜ 6 (P ＜ 0.001).AUC of MLR staging was 0.72 ± 0.04 at numbers 6-10 (P ＜ 0.001).AUC of MLR staging was 0.79 ± 0.03 when numbers ＞ 10 (P ＜ 0.001).Conclusions MLR was less influenced by lymph node number examined than N.MLR stage has potential superiority to that the N stage in assessing prognosis of GC patients,especially for patients with more than 6 lymph nodes examined.

Objective To investigate the effect of the pregnancy factor on the line drawn between the highest points of the two iliac crests ( T line) corresponding to the vertebral level in a multicenter clini?cal comparative study. Methods Hospitalized patients selected from the obstetric department or gynecolog?ical department, of American Society of Anesthesiologists physical statusⅠorⅡ, were divided into preg?nancy group ( group P ) and non?pregnancy group ( group NP ) . The patients were placed in the lateral posi?tion with their back vertical to the bed surface, the patient′s thighs were at an angle of approximately 90 de?grees to the trunk, and hip flexion was employed by flexing the patient′s knees to the chest. To determine the highest points of the two iliac crests, a line ( T line) was drawn between the highest points using a wire?reinforced epidural catheter. And another vertical line ( T′line) was made between the highest point of the iliac crest on the upper side ( not the side in the lateral position) and the ground. Ultrasonography was per?formed to identify and record the level of T line and T′line corresponding to the spinous process and lumbar interspace. Results A total of 1 763 cases completed the study, and there were 905 cases in group P, and 858 cases in group NP. Compared with group NP, the rate of T line at L3 spinous process and L3,4 in?terspace was significantly increased in group P ( P<0.05) . Compared with T′line, the rate of T line at L2,3 interspace and L3 spinous process was significantly decreased, and the rate of T line at L4 spinous process, L4,5 interspace and L5 spinous process was significantly increased in group P, and the rate of T line at L3 spinous process, L2,3 interspace and L3,4 interspace was significantly decreased, and the rate of T line at L4 spinous process and L4,5 interspace was significantly increased in group NP (P<0.01). Conclusion The level of T line corresponding to the vertebral level is significantly higher in the pregnant patients than in the nonpregnant patients.

OBJECTIVETo investigate the effects of β-elemene in suppressing the proliferation and apoptosis of SGC7901 gastric cancer cells in vitro and explore the underlying mechanisms.

METHODSUsing MTT assay, flow cytometry, and clonogenic survival assay, we assessed the effects of β-elemene on the viability, apoptosis, cell cycle distribution, and clonogenic survival of gastric cancer SGC7901 cells and gastric mucosal epithelial GES-1 cells. Western blotting was employed to determine the changes in the protein expression profiles in SGC7901 cells in response to β-elemene treatment.

RESULTSβ-elemene significantly suppressed the cell viability and increased the apoptosis of SGC7901 cells, and these effects were less obvious in GES-1 cells. β-elemene decreased clonogenic survival of SGC7901 cells, increased the proportion of G2/M phase cells, decreased the expression of Bcl-2, and increased the expression of Bax and cleaved caspase-3. β-elemene did not obviously affect the expression of total p21-activated protein kinase 1 (Pak1) but decreased the level of phospho-Pak1 (Thr423) and phospho-ERK1/2 (Thr202/Tyr204) in SGC7901 cells.

CONCLUSIONβ-elemene inhibits the proliferation and induces apoptosis of gastric cancer cells possibly by inhibiting Pak1/ERK signaling and regulating apoptosis-associated proteins such as Bcl-2 and Bax.

Apoptosis ; Apoptosis Regulatory Proteins ; metabolism ; Cell Cycle ; Cell Division ; Cell Line, Tumor ; drug effects ; Cell Proliferation ; Cell Survival ; Humans ; Sesquiterpenes ; pharmacology ; Signal Transduction ; Stomach Neoplasms ; pathology

Objective To evaluate the effect of labor analgesia on the development of postpartum depression.Methods Seventy nulliparous parturients who were at full term with a singleton fetus in vertex presentation,aged 20-35 yr,with body mass index＜27 kg/m2,at 38-41 weeks of gestation,of ASA physical status Ⅰ,were enrolled and divided into 2 groups (n =35 each) using a random number table:vaginal delivery group (group VD) and labor analgesia group (group LA).In LA group,the epidural catheter was placed at L2,3 interspace for combined spinal-epidural analgesia when their cervical dilations were in 2-3 cm.VAS score was maintained below 3 after the analgesia.Parturients completed Edinburgh Postnatal Depression Scale questionnaires 42 days after the labor.The development of depression was recorded.Results The incidence of postnatal depression was significantly lower in LA group (17％) than in VD group (40％).Conclusion Labor analgesia can decrease the development of postpartum depression.

Objective To explore the effects of obesity on the survival,growth and proliferation of gastric cancer and apoptosis by in vivo experiments so as to clarify the relationship between obesity and gastric cancer. Methods High fat diet-induced obese mice model was established.MFC cells were inoculated subcutaneously into mice to establish xenograft tumor model;then tumor growth and peritoneal metastasis were observed for 2 weeks. At the end of in vivo experiments,serum insulin and visfatin concentrations were assayed by ELISA,and blood glucose was determined by glucometer.MFC cell proliferation and apoptosis,as well as the number and size of adipocytes in xenograft tumor tissues were analyzed by immunohistochemistry, TUNEL and HE staining, respectively.Results High fat diet-induced obese mice model was successfully established within 12 weeks,and 66.7% of mice in the model were obese.Obese mice had distinct metabolic changes manifested as weight gain,high blood glucose,high serum visfatin,hyperinsulinemia and insulin resistance.All mice survived and developed no metastasis.The tumors from obese mice had a larger volume,heavier weight and greater intra-tumoral adipocytes, and exhibited higher proliferation and reduced apoptosis rate compared to those of non-obese and lean mice.Both serum insulin and visfatin concentrations correlated positively with tumor proliferation and negatively with tumor apoptosis.In addition,tumor weight showed a significantly positive correlation with mice body weight.Effects of diet-induced obesity on gastric cancer were not related to the influence of diet,but to the degree of obesity. Conclusion The altered adipocytokine milieu and insulin resistance observed in obesity may lead directly to alterations in tumor microenvironment,thereby promoting the survival and growth of gastric cancer.

Objective To investigate the effect of β-elemene on SGC7901 gastric cancer cell line and the potential proteins involved. Methods Human SGC7901 gastric cancer cells were treated with different concentrations ofβ-elemene.Cell viability was assessed.A proteomic method,isobaric tags for relative and absolute quantitation (iTRAQ),was employed to detect the proteins altered by β-elemene.Protein expression was validated by Western blot.Results β-elemene inhibited the viability of SGC7901 gastric cancer cells in a dose-dependent manner.Altogether,147 upregulated proteins and 86 downregulated proteins were identified in response to β-elemene treatment in SGC7901 gastric cancer cell line.Among them,the expressions of p21-activated protein kinase-interacting protein 1 (PAK1IP1 ),Bcl-2-associated transcription factor 1 (BTF)and topoisomerase 2-alpha (TOPIIα)were validated by Western blot and the trends were consistent with iTRAQ results.Top pathways involved inβ-elemene treatment in SGC7901 gastric cancer cell line included ribosome signaling,peroxisome proliferator-activated receptors (PPARs)signaling pathway,regulation of actin cytoskeleton,phagosome,biosynthesis and metabolism of some amino acids.Conclusion Our results suggest a promising therapeutic role of β-elemene for gastric cancer.The differentially expressed proteins give us better insights into the potential mechanisms involved in gastric cancer treatment using β-elemene.