[Purpose]To analyze the incidence and mortality of gastric cancer in Zhejiang cancer registration areas in 2021,and trends from 2000 to 2021.[Methods]The data of gastric cancer were obtained from Zhejiang cancer registration areas.The crude incidence/mortality rates,age-specific rates,and age-standardized incidence/mortality rates by Chinese standard population(ASRC)and the world standard population(ASRW)were calculated.The temporal trends were ana-lyzed by calculating annual percentage change(APC)and average annual percentage change(AAPC).[Results]A total of 7 602 new cases and 4 178 deaths of gastric cancer were reported in 2021.The incidence and mortality rates of gastric cancer in men were significantly higher than those in women;the incidence rate in urban areas was significantly higher than that in rural areas,while the mortality was slightly lower than that in rural areas.From 2000 to 2021,the ASRC of inci-dence rate decreased from 16.80/105 to 16.08/105(without statistical significance):an upward trend was observed from 2000 to 2009,whereas a downward trend became apparent from 2009 to 2021.From 2000 to 2021 the ASRC of mortality rate decreased from 13.59/105 to 8.02/105 with an AAPC of-2.62％(P＜0.001).The decline rate of female mortality rate(AAPC=-2.68％,95％CI:-3.61％～-1.68％,P＜0.001)was slightly higher than that of male(AAPC=-2.44％,95％CI:-3.06％～-1.61％,P＜0.001).[Conclusion]In 2021,both the incidence and mortality rates of gastric can-cer in Zhejiang Province were lower than the national average in China,which ranked 6th and 4th among all types of cancer.From 2000 to 2021,the overall burden of gastric cancer in Zhejiang Province showed a downward trend.

OBJECTIVE To prepare hyaluronic acid(HA)-modified emodin(EMD)-contained multi-walled carbon nanotubes(MWCNTs)drug delivery system(HA-MWCNTs-EMD)and explore its in vitro inhibitory effect on breast cancer cells.METHODS EMD was loaded onto MWCNTs to prepare a drug delivery system MWCNTs-EMD;subsequently,the system was further modified with HA to obtain the drug delivery system HA-MWCNTs-EMD.The two drug delivery systems mentioned above were characterized.With free EMD as the reference,the drug release in vitro of the above two drug delivery systems was investigated;the uptake of EMD by two breast cancer cells(MCF-7,MDA-MB-231 cells)was detected.The impacts of the above two drug delivery systems on the expression of surface glycoprotein differentiation group 44(CD44),activity,apoptosis and lactate dehydrogenase(LDH)release of two breast cancer cells were detected.RESULTS The encapsulation efficiencies of MWCNTs-EMD and HA-MWCNTs-EMD were both(63.52±2.74)%,with drug loading rates of(25.01±1.83)%and(12.13±1.96)%,particle sizes of(865.95±2.16)and(351.86±1.68)nm,polydispersity indexes of 0.54±0.02 and 0.23±0.01,and Zeta potentials of(23.87±0.14)and(-42.79±0.39)mV,respectively.The 2,4,6,8,10,12 and 24-hour cumulative release rates of EMD in MWCNTs-EMD and HA-MWCNTs-EMD were significantly lower than those in free EMD,while the cumulative release rate of HA-MWCNTs-EMD was significantly higher than that of MWCNTs-EMD(P＜0.05);the EMD uptakes of MWCNTs-EMD and HA-MWCNTs-EMD by the two types of breast cancer cells were significantly higher than their uptake of free EMD(P＜0.05).Compared with the free EMD group,the MWCNTs-EMD and MWCNTs-EMD groups showed significantly higher apoptosis rate and LDH release,significantly lower surface CD44 expression(except for the MWCNTs-EMD group)and cell viability in both cell types,and the effect of HA-MWCNTs-EMD was more pronounced(P＜0.05).CONCLUSIONS A novel drug delivery system HA-MWCNTs-EMD loaded with EMD is developed successfully;the drug delivery system has a certain slow-release effect,which can significantly reduce the activity of breast cancer cells,promote their apoptosis and increase the release of LDH,and the above anti-breast cancer effect is significantly stronger than that of free EMD and MWCNTs-EMD.

[Purpose]To analyze the incidence and mortality of gastric cancer in Zhejiang cancer registration areas in 2021,and trends from 2000 to 2021.[Methods]The data of gastric cancer were obtained from Zhejiang cancer registration areas.The crude incidence/mortality rates,age-specific rates,and age-standardized incidence/mortality rates by Chinese standard population(ASRC)and the world standard population(ASRW)were calculated.The temporal trends were ana-lyzed by calculating annual percentage change(APC)and average annual percentage change(AAPC).[Results]A total of 7 602 new cases and 4 178 deaths of gastric cancer were reported in 2021.The incidence and mortality rates of gastric cancer in men were significantly higher than those in women;the incidence rate in urban areas was significantly higher than that in rural areas,while the mortality was slightly lower than that in rural areas.From 2000 to 2021,the ASRC of inci-dence rate decreased from 16.80/105 to 16.08/105(without statistical significance):an upward trend was observed from 2000 to 2009,whereas a downward trend became apparent from 2009 to 2021.From 2000 to 2021 the ASRC of mortality rate decreased from 13.59/105 to 8.02/105 with an AAPC of-2.62％(P＜0.001).The decline rate of female mortality rate(AAPC=-2.68％,95％CI:-3.61％～-1.68％,P＜0.001)was slightly higher than that of male(AAPC=-2.44％,95％CI:-3.06％～-1.61％,P＜0.001).[Conclusion]In 2021,both the incidence and mortality rates of gastric can-cer in Zhejiang Province were lower than the national average in China,which ranked 6th and 4th among all types of cancer.From 2000 to 2021,the overall burden of gastric cancer in Zhejiang Province showed a downward trend.

Objective:To investigate the efficacy of fixation through dual minimally invasive incisions and dual osseous channels with a loop titanium plate combined with a Dog-Bone titanium plate for acute Rockwood Ⅲ acromioclavicular dislocation in comparison with open reduction and fixation with a clavicular hook plate.Methods:A retrospective study was conducted to analyze the data of the 60 patients with acute type Ⅲ acromioclavicular dislocation who had been treated at Department of Orthopedics, Liaocheng People's Hospital from February 2019 to May 2022. There were 35 males and 25 females with an age of (43.2±8.0) years, and 34 left sides and 26 right sides affected. According to different surgical methods, they were divided into a double titanium plates group of 32 cases who had been treated by fixation through dual minimally invasive incisions and dual osseous channels with a loop titanium plate combined with a Dog Bone titanium plate and a hook plate group of 28 cases who had been treated by open reduction and internal fixation with a clavicle hook plate. The time from injury to operation was (2.1±1.3) d. The 2 groups were compared in terms of incision length, operation time, intraoperative bleeding, and visual analogue scale (VAS) pain score, Constant-Murley shoulder function score and the coracoclavicular distance on the affected side which were recorded preoperatively and at the last follow-up. Complications such as infection, loosening of internal fixation or secondary fracture were observed.Results:There was no statistically significant difference in the preoperative general data between the 2 groups, indicating comparability ( P > 0.05). All patients were followed up for (11.2±2.1) months. The incision length in the double titanium plates group [(3.5±0.3) cm] was significantly shorter than that in the hook plate group [(6.2±0.7) cm], and the intraoperative bleeding [(45.3±7.5) mL] in the former was significantly less than that in the latter [(64.1±6.2) mL] ( P < 0.05). However, there was no statistically significant difference in the operation time between the 2 groups ( P > 0.05). The VAS score [0.5 (0, 1.0) points] and Constant-Murley shoulder function score [(95.1±2.1) points] in the double titanium plates group were significantly better than those in the hook plate group [0.8 (0, 1.0) points, (86.0±4.4) points] at the last follow-up ( P < 0.05). However, there was no statistically significant difference between the 2 groups in the coracoclavicular distance on the affected side ( P > 0.05). Good acromioclavicular joint repositioning and fixation were achieved in all patients. There were no surgery-related complications except for sinus tract formation in one patient in the double titanium plates group. Conclusion:In the treatment of acute Rockwood Ⅲ acromioclavicular dislocation, fixation through dual minimally invasive incisions and dual osseous channels with a loop titanium plate combined with a Dog-Bone titanium plate is superior to open reduction and internal fixation with a clavicular hook plate, showing advantages of minimal invasion, better safety, less intraoperative bleeding, and faster joint function recovery.

Objective To analyze the data on the pathogenic bacteria responsible for infected pan creatic necrosis (IPN) and drug resistance,and to study the impact on prognosis of patients.Methods The clinical data from 101 patients who were diagnosed to have IPN in the Xuanwu Hospital of the Capital Medical University,Beijing,from January 2011 to August 2017,were analyzed retrospectively.Logistic regression and statistical analysis were performed to evaluate the species composition and drug-resistance in the pathogens obtained from the pancreatic necrosis tissues or the drainage culture fluids from these IPN patients in the first,second or third surgery.Results Among the 101 patients,80 had bacteria-positive cultures,of which 97 were pathogenic bacteria:74.2％ were Gram-negative,22.7％ were Gram-positive,and 3.1％ were fungi.The commonest bacterial strains included Escherichia coli (n =20),Klebsiella pneumonia (n =17),Pseudomonas aeruginosa (n =13),Acinetobacter baumannii (n =11),and Enterococcus (hereafter called Ent.) faecium (n =11).Drug resistance analysis showed that the Gram-negative bacilli were susceptible to carbapenems.The resistance rates for all the antibiotic types in K.pneumoniae exceeded 50％.The use of enzyme inhibitors significantly improved bacterial sensitivity to the beta-lactams.The Gram-positive bacteria were sensitive to vancomycin and tigecycline.Drug-resistant fungi were not identified.The multidrug resistance rates for E.coli,K.pneumoniae,P.aeruginosa and A.baumannii Gram-negative bacilli were 35.0％ (7/20),76.5％ (13/17),53.9％ (7/13) and 63.6％ (7/11),respectively,while that for Gram-positive Ent.faecium was 75.0％ (9/12).Forty patients underwent three or more surgeries.Regression analysis showed that the proportion of patients with severe acute pancreatitis who underwent three or more surgeries was higher than that of the patients who underwent fewer surgeries.However,neither the number of overall infections,nor the number of infections with multiple drug-resistant pathogens,was associated with the number of operations.Conclusions Gram-negative bacilli was mainly involved in the primary infections of patients with IPN.E.coli was the most common microbe.Our clinical experience showed that enzyme penicillins or carbapenems were the preferred treatment options.

Objective To observe the outcomes of no necrotic cavity lavage after debridement and drainage in patients with infected pancreatic necrosis (IPN).Methods From February 2014 to August 2017,there were 89 patients who were diagnosed as IPN undergoing minimally invasive surgery with no necrotic cavity lavage and large caliber-wide channel drainage in Department of General Surgery,Xuanwu Hospital,Capital Medical University.There were 57 male and 32 female patients aging of (49.5± 14.4)years (ranging from 23 to 84 years).The body mass index of 89 patients was (25.4± 3.8) kg/m2 (ranging from 17.6 to 36.7 kg/m2).Among the 89 patients,37 cases(41.6％) of biliary pancreatitis,10 cases (11.2％) of alcoholic pancreatitis,16 cases (18.0％) of hyperlipidemic pancreatitis,and 26 cases (29.2％) of other reasons.Results Of 89 patients,IPN in 6 patients (6.7％) resolved using only percutaneous catheter drainage;another 83 patients underwent laparoscopic debridement (n =3,3.4％) or video-assisted debridement (n =80,89.9％).No patient was conversed to laparotomy.The average operation frequency and surgery time was (2.3±1.7) times and (56.5±31.7) minutes.The median bleeding volume and total length of stay was 10(0-600) ml and 34(6-172) days separately.The complication rate(Clavien-Dindo grade ≥Ⅲ) was 9.0％ (8/89) which involved mainly abdominal hemorrhage (5/8) and digestive tract fistula formation (3/8).The overall mortality rate was 6.7％ (6/89).Among them,3 cases died of abdominal infection,bacteremia and multiple organ failure,2 cases died of pulmonary infection and bacteremia and 1 case died of fungal infection.Conclusion No necrotic cavity lavage after debridement and drainage operation is considered effective and safe for IPN patients.

Objective To observe the outcomes of no necrotic cavity lavage after debridement and drainage in patients with infected pancreatic necrosis (IPN).Methods From February 2014 to August 2017,there were 89 patients who were diagnosed as IPN undergoing minimally invasive surgery with no necrotic cavity lavage and large caliber-wide channel drainage in Department of General Surgery,Xuanwu Hospital,Capital Medical University.There were 57 male and 32 female patients aging of (49.5± 14.4)years (ranging from 23 to 84 years).The body mass index of 89 patients was (25.4± 3.8) kg/m2 (ranging from 17.6 to 36.7 kg/m2).Among the 89 patients,37 cases(41.6％) of biliary pancreatitis,10 cases (11.2％) of alcoholic pancreatitis,16 cases (18.0％) of hyperlipidemic pancreatitis,and 26 cases (29.2％) of other reasons.Results Of 89 patients,IPN in 6 patients (6.7％) resolved using only percutaneous catheter drainage;another 83 patients underwent laparoscopic debridement (n =3,3.4％) or video-assisted debridement (n =80,89.9％).No patient was conversed to laparotomy.The average operation frequency and surgery time was (2.3±1.7) times and (56.5±31.7) minutes.The median bleeding volume and total length of stay was 10(0-600) ml and 34(6-172) days separately.The complication rate(Clavien-Dindo grade ≥Ⅲ) was 9.0％ (8/89) which involved mainly abdominal hemorrhage (5/8) and digestive tract fistula formation (3/8).The overall mortality rate was 6.7％ (6/89).Among them,3 cases died of abdominal infection,bacteremia and multiple organ failure,2 cases died of pulmonary infection and bacteremia and 1 case died of fungal infection.Conclusion No necrotic cavity lavage after debridement and drainage operation is considered effective and safe for IPN patients.

Objective To observe the influence on the sensitivity of pancreatic cancer cell line BxPC-3 to gemcitabine of silencing PAUF gene.Methods BxPC-3 cells,which overexpress PAUF,was stably transfected with PAUF-shCtrl and PAUF-shRNA to establish BxPC-3_shCtrl and BxPC-3_shPAUF cells as control and experiment group.Then the mRNA and protein expression level of PAUF in these two cell lines were detected by RT-PCR and western blot,respectively.The growth inhibition rates of these two cell lines treated with different concentrations of gemcitabine (0,3.1,6.25,12.5,25,50,100,200 nmol/L) were detected by MTT.Apoptosis rates in the cells treated with different concentrations of gemcitabine (0,75,100 nmol/L) were then observed by flow cytometry.Results The relative PAUF mRNA expression level in BxPC-3_shCtrl and BxPC-3 cells were 1.00 ± 0.06 and 0.83 ± 0.07,which were significantly high er than that in BxPC-3_shPAUF cells (0.25 ± 0.02;both P ＜ 0.05).The relative PAUF protein expression level in BxPC-3_shCtrl and BxPC-3 cells were 0.89 ± 0.07 and 0.95 ± 0.04,which were significantly high er than that in BxPC-3_shPAUF cells (0.31 ± 0.03;both P ＜ 0.05).The IC50 value of gemcitabine to BxPC-3_shCtrl cell was (22.88 ± 2.43) nmol/L,which was significantly higher than that of BxPC-3_shPAUF cells [(1.06 ± 0.02) nmol/L;P ＜ 0.05];apoptosis rate of BxPC-3_shPAUF cells treated by gemcitabine increased faster than that of BxPC-3_shCtrl cells.Conclusion PAUF silencing could greatly enhance the sensitivity of BxPC-3 cells to gemcitabine.