Gastric cancer is one of the most common digestive system malignancies in China. Most patients are diagnosed at an advanced stage (Stage Ⅲ-Ⅳ), with poor prognosis and great difficulty in treatment. This article systematically summarizes the epidemiological characteristics, diagnostic methods, and comprehensive treatment strategies for advanced gastric cancer. In terms of diagnosis: although serum tumor markers have value in dynamic monitoring, their specificity is limited; molecular markers have gradually become the core basis for precision treatment; imaging, gastroscopy, and laparoscopy form a complementary diagnostic chain, which can improve the accuracy of staging. In terms of treatment: radical surgery remains the main treatment method, emphasizing R0 resection and standardized D2 lymph node dissection; palliative surgery aims to relieve symptoms and improve quality of life. In recent years, the development of conversion therapy has provided surgical opportunities for some initially unresectable patients; local treatments such as proton radiotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC), and radiofrequency ablation also have value in specific populations. The multidisciplinary team (MDT) model and individualized treatment guided by molecular typing have become future development trends. Although problems such as drug resistance and low detection rate of peritoneal metastasis still exist, the application of cytological examination, multi-omics integration, artificial intelligence-assisted diagnosis and treatment, and new targeted and immunotherapies is expected to break through the current bottlenecks in the treatment of advanced gastric cancer and improve patients′ survival and quality of life.

Objective:To explore the correlation between serum carbohydrate antigen 72-4 (CA72-4) level and pathological differentiation degree of gastric cancer, and to provide reference for early diagnosis, prognosis evaluation and efficacy monitoring of gastric cancer.Methods:A retrospective study was conducted on 136 patients with gastric cancer admitted to Zhejiang Provincial People′s Hospital from April 2022 to December 2024. According to postoperative pathological diagnosis, patients were divided into well-differentiated group ( n=9), moderately differentiated group ( n=36) and poorly/undifferentiated group ( n=91). Preoperative CA72-4 levels and clinical characteristics of patients were collected to analyze the relationship between differentiation degree and CA72-4 level, and to compare the changes of CA72-4 before and after surgery in gastric cancer patients with different differentiation degrees. Results:The preoperative CA72-4 level in the poorly/undifferentiated group was significantly higher than that in the well-differentiated group and moderately differentiated group (all P<0.001). Preoperative CA72-4 level in gastric cancer patients was weakly negatively correlated with differentiation degree ( R=-0.341). After surgery, the CA72-4 level in the poorly/undifferentiated group decreased significantly compared with that before surgery ( P=0.043), while the changes in the well-differentiated group and moderately differentiated group were not significant. Conclusions:There are significant differences in CA72-4 levels among gastric cancer groups with different differentiation degrees. Preoperative CA72-4, as a tumor marker, is of great significance for early diagnosis, prognosis evaluation and postoperative monitoring of gastric cancer. Especially in patients with poorly/undifferentiated gastric cancer, the CA72-4 level is relatively high, which can be used for auxiliary diagnosis and formulation of treatment plans.

Gastric cancer is one of the most common digestive system malignancies in China. Most patients are diagnosed at an advanced stage (Stage Ⅲ-Ⅳ), with poor prognosis and great difficulty in treatment. This article systematically summarizes the epidemiological characteristics, diagnostic methods, and comprehensive treatment strategies for advanced gastric cancer. In terms of diagnosis: although serum tumor markers have value in dynamic monitoring, their specificity is limited; molecular markers have gradually become the core basis for precision treatment; imaging, gastroscopy, and laparoscopy form a complementary diagnostic chain, which can improve the accuracy of staging. In terms of treatment: radical surgery remains the main treatment method, emphasizing R0 resection and standardized D2 lymph node dissection; palliative surgery aims to relieve symptoms and improve quality of life. In recent years, the development of conversion therapy has provided surgical opportunities for some initially unresectable patients; local treatments such as proton radiotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC), and radiofrequency ablation also have value in specific populations. The multidisciplinary team (MDT) model and individualized treatment guided by molecular typing have become future development trends. Although problems such as drug resistance and low detection rate of peritoneal metastasis still exist, the application of cytological examination, multi-omics integration, artificial intelligence-assisted diagnosis and treatment, and new targeted and immunotherapies is expected to break through the current bottlenecks in the treatment of advanced gastric cancer and improve patients′ survival and quality of life.

Objective:To explore the correlation between serum carbohydrate antigen 72-4 (CA72-4) level and pathological differentiation degree of gastric cancer, and to provide reference for early diagnosis, prognosis evaluation and efficacy monitoring of gastric cancer.Methods:A retrospective study was conducted on 136 patients with gastric cancer admitted to Zhejiang Provincial People′s Hospital from April 2022 to December 2024. According to postoperative pathological diagnosis, patients were divided into well-differentiated group ( n=9), moderately differentiated group ( n=36) and poorly/undifferentiated group ( n=91). Preoperative CA72-4 levels and clinical characteristics of patients were collected to analyze the relationship between differentiation degree and CA72-4 level, and to compare the changes of CA72-4 before and after surgery in gastric cancer patients with different differentiation degrees. Results:The preoperative CA72-4 level in the poorly/undifferentiated group was significantly higher than that in the well-differentiated group and moderately differentiated group (all P<0.001). Preoperative CA72-4 level in gastric cancer patients was weakly negatively correlated with differentiation degree ( R=-0.341). After surgery, the CA72-4 level in the poorly/undifferentiated group decreased significantly compared with that before surgery ( P=0.043), while the changes in the well-differentiated group and moderately differentiated group were not significant. Conclusions:There are significant differences in CA72-4 levels among gastric cancer groups with different differentiation degrees. Preoperative CA72-4, as a tumor marker, is of great significance for early diagnosis, prognosis evaluation and postoperative monitoring of gastric cancer. Especially in patients with poorly/undifferentiated gastric cancer, the CA72-4 level is relatively high, which can be used for auxiliary diagnosis and formulation of treatment plans.

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor originating from the gastrointestinal tract, mainly associated with KIT and PDGFRA gene mutations, and related to factors such as patient age, gender, and pathological differentiation level. The clinical manifestations of GIST include abdominal pain, indigestion, gastrointestinal bleeding, etc. The diagnostic methods involve endoscopy, imaging examination, and pathological evaluation. The treatment strategy for GIST is customized based on tumor characteristics and individual circumstances, including surgery, drug therapy, and targeted therapy. With the development of molecular biology, the understanding of GIST has become increasingly profound, and various diagnostic techniques and treatments for GIST have made new progress, especially in individualization, precision medicine, and targeted therapy.

Objective:To explore the application value of intraoperative ultrasound localization in laparoscopic surgery for non extraluminal gastrointestinal stromal tumors.Methods:A retrospective analysis was conducted on the clinical data of 13 patients with non extraluminal gastrointestinal stromal tumors treated with laparoscopic surgery at Zhejiang Provincial People′s Hospital from January 2023 to March 2024. Ultrasound localization was used during the surgery. An analysis was conducted on indicators such as the patient′s surgical approach, surgical duration, intraoperative blood loss, time of first postoperative meal intake, length of hospital stay, and incidence of postoperative complications.Results:Among the 13 patients, there were 7 males and 6 females, and all patients successfully completed the surgery. The operation time was (71.54±19.51)minutes, the intraoperative blood loss was (20.0±16.8)ml, the first postoperative feeding time was (3.08±1.38)days, and the postoperative hospitalization time was (6.92±2.69)days. All 13 patients did not undergo conversion to open surgery during the operation, and the operation was smooth. There was no major bleeding or iatrogenic injury during the operation. There was no bleeding, abdominal infection, anastomotic fistula, anastomotic stenosis, etc. after the operation. There were no unplanned cases of reoperation, and all recovered well and were discharged smoothly. There were no discomfort symptoms during the 3-month follow-up after the operation.Conclusions:Intraoperative ultrasound can accurately locate tumors in laparoscopic non cavity growth gastrointestinal stromal tumor surgery, which is beneficial for the smooth progress of the surgery and the formulation of surgical strategies, and has obvious safety and reliability.

Objective:To compare the therapeutic effects of surgical resection combined with tyrosine kinase inhibitors (TKI) and TKI alone in patients with recurrent or metastatic gastrointestinal stromal tumors (GIST).Methods:Literature was searched in databases such as PubMed and Web of Science, and relevant literature on the application of surgical resection combined with TKI and TKI alone in patients with recurrent or metastatic GIST was selected strictly according to inclusion criteria. Meta analysis was conducted on the survival benefits of patients, including progression free survival (PFS) and overall survival (OS).Results:A total of 647 patients from 8 studies were included in this meta-analysis, with 6 studies conducted in Asia and 2 in Europe. The Newcastle Ottawa Quality Assessment Scale scores were all ≥6. Eight studies were conducted to evaluate the overall survival of patients treated with surgical resection combined with TKI and TKI alone, with four studies simultaneously assessing PFS. The meta-analysis results showed that compared with TKI treatment alone, surgical resection combined with TKI treatment significantly improved the overall survival (OS) of patients with recurrent or metastatic GIST ( P<0.001). Conclusions:For patients with recurrent or metastatic GIST, compared to simple TKI treatment, surgical resection of residual lesions after TKI (such as imatinib) control of the condition brings significant survival benefits to patients. Combining surgical intervention with TKI treatment should be considered a feasible treatment strategy to improve the prognosis of patients with recurrent or metastatic GIST.

Objective:To explore the feasibility and therapeutic effect of Roux-en-Y anastomosis through a small incision in laparoscopic distal gastrectomy for gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of 34 patients who underwent laparoscopic distal gastrectomy for gastric cancer through Roux-en-Y anastomosis through small incisions in the Gastrointestinal and Pancreatic Surgery Department of the Zhejiang Provincial People′s Hospital from August 2022 to May 2023.Results:Among the 34 patients, there were 27 males and 7 females, aged (63.6±14.6)years old. All cases underwent surgery successfully and there were no cases of conversion to open surgery. The reconstruction time of the digestive tract was (30.74±3.29)minutes, the intraoperative bleeding volume was (60.29±29.59)ml, the intraoperative lymph nodes were cleaned (32.00±11.00), the incision length of the specimen was (5.88±0.98)cm, the postoperative exhaust time was (1.88±0.73)days, and the postoperative hospitalization time was (11.94±3.87)days. There were no postoperative cases of anastomotic leakage, anastomotic stenosis, bleeding, or unplanned reoperation in patients. After a postoperative follow-up of 3-12 months, there were no recurrence or death cases, and no postoperative reflux cases during the follow-up period.Conclusions:Laparoscopic distal gastrectomy with Roux-en-Y anastomosis through a small incision can effectively reduce postoperative complications, especially the occurrence of postoperative reflux. In addition, this surgical procedure can simplify the surgical steps, shorten the surgical time, promote postoperative recovery, and improve postoperative quality of life.

【Objective】 To evaluate the protective effect of siNLRP3-loaded nanosystem on diabetic cardiomyopathy (DCM) via silencing NLRP3 under ultrasound-targeted microbubble blasting (UTMD). 【Methods】 After synthesis of polyethylene glycol polylysine block copolymer (mPEG-b-PLLys), siNLRP3-loaded hetero-assembled nanosystem system (siNLRP3-NBs) was constructed and characterized. Subsequently, a DCM rat model was established to investigate the protective effect of siNLRP3-NBS on the heart. Cardiac function of the rats was observed by small animal ultrasonography. HE and Masson staining were used to observe the degree of myocardial fibrosis change; the protein expression of NLRP3 and cell pyroptosis indexes were detected by Western blotting. 【Results】 ¹H NMR indicated that the structure of mPEG-b-PLLys was correct. The results of agarose electrophoresis showed that NBs could protect naked siNLRP3 from RNAase degradation, and the particle size and zeta potential of siNLRP3-NBs were (379.7±14.8) nm and (8.73±1.93) mV, respectively. The shape of NBs was almost spherical. siNLRP3-NBs combined with UTMD could enhance the protective effect on cardiac function and improve myocardial fibrosis in DCM rats. Protein expression indicated that UTMD could enhance the inhibitory effect of siNLRP3-NBS on cardiomyocyte pyroptosis. 【Conclusion】 UTMD-mediated ultrasonic response combined nanosystem can enhance the therapeutic effect of siNLRP3 on DCM, suggesting that ultrasonic response siNLRP3-loaded nanosystem is a potentially effective strategy for the treatment of heart disease.

Professor's experience of diagnosis and treatment for intractable facial paralysis is introduced. Professorfocuses on the thinking model that combines TCM, western medicine and acupuncture, and adopts the differentiation system that combines disease differentiation, syndrome differentiation and meridian differentiation; he adopts the treatment integrates etiological treatment, overall regulation, symptomatic treatment as well as acupuncture, moxibustion, medication and flash cupping. The acupoints ofmeridians are mostly selected, and acupoints of governor vessel such as Dazhui (GV 14) and Jinsuo (GV 8) are highly valued. The multiple-needles shallow-penetration-insertion twirling lifting and thrusting technique are mostly adopted to achieve slow and mild acupuncture sensation; in addition, the facial muscles are pulled up with mechanics action. The intensive stimulation with electroacupuncture is recommended at Qianzheng (Extra), Yifeng (TE 17) and Yangbai (GB 14), which is given two or three treatments per week.