Objective:To evaluate immunotherapy combined with neoadjuvant chemotherapy before radical total gastrectomy in microsatellite stable locally advanced gastric cancer in two cases.Methods:Two male patients with clinical stage cT3N 1M0 and microsatellite-stable locally advanced gastric cancer were treated with neoadjuvant chemotherapy with PD-1 inhibitor (Nivolumab) combined with SOX (Oxaliplatin+S-1) for 4 cycles before surgery. Standard laparoscopic assisted total gastrectomy with D 2 lymphadenectomy was performed on Feb 2023 and Oct 2023 respectively after the neoadjuvant treatment. Pathological tumor regression grade(TRG) was observed to assess the degree of tumor regression, and follow-up was conducted to monitor tumor markers and abdominal enhanced CT to detect recurrence. Results:Two patients achieved pathological complete response(TRG0). They were followed up until May 2024 and no recurrence was observed.Conclusion:Preoperative combination of chemotherapy and immunotherapy may provide survival benefit for microsatellite stable locally advanced gastric cancer patients.

Objective This study aims to investigate and analyze the effects of the incentive-coordination-supervision mechanism applied to training management of medical staff under the modern hospital management system.Methods A total of 84 medical staff members working at the hospital from February 2022 to February 2024 were selected for the study.They were di-vided into a reference group(n=42,February 2022 to February 2023)and a study group(n=42,March 2023 to February 2024)based on the time period.The reference group underwent routine management,while the study group underwent manage-ment based on the incentive-coordination-supervision mechanism.The quality of management,occurrence of adverse events,management satisfaction,and core competencies were compared between the two groups.Results The study group had higher scores in cultural construction,reward and punishment mechanism,reporting system,and communication and coordination mech-anism than the reference group(all P＜0.05).The occurrence rate of adverse events was lower in the study group than in the reference group(7.14％vs 23.81％)(P＜0.05).The study group had higher satisfaction rates in management methods,man-agement content,management forms,and communication skills(95.24％,92.86％,97.62％,and 95.24％,respectively)compared to the reference group(78.57％,73.81％,76.19％,and 73.81％,respectively)(all P＜0.05).The study group had higher scores in all core competencies compared to the reference group(all P＜0.05).Conclusion The application of the incentive-coordination-supervision mechanism in training management of medical staff shows favorable effects,improving the qual-ity of management,management satisfaction,and core competencies,and reducing the occurrence of adverse events.

Objective This study aims to investigate and analyze the effects of the incentive-coordination-supervision mechanism applied to training management of medical staff under the modern hospital management system.Methods A total of 84 medical staff members working at the hospital from February 2022 to February 2024 were selected for the study.They were di-vided into a reference group(n=42,February 2022 to February 2023)and a study group(n=42,March 2023 to February 2024)based on the time period.The reference group underwent routine management,while the study group underwent manage-ment based on the incentive-coordination-supervision mechanism.The quality of management,occurrence of adverse events,management satisfaction,and core competencies were compared between the two groups.Results The study group had higher scores in cultural construction,reward and punishment mechanism,reporting system,and communication and coordination mech-anism than the reference group(all P＜0.05).The occurrence rate of adverse events was lower in the study group than in the reference group(7.14％vs 23.81％)(P＜0.05).The study group had higher satisfaction rates in management methods,man-agement content,management forms,and communication skills(95.24％,92.86％,97.62％,and 95.24％,respectively)compared to the reference group(78.57％,73.81％,76.19％,and 73.81％,respectively)(all P＜0.05).The study group had higher scores in all core competencies compared to the reference group(all P＜0.05).Conclusion The application of the incentive-coordination-supervision mechanism in training management of medical staff shows favorable effects,improving the qual-ity of management,management satisfaction,and core competencies,and reducing the occurrence of adverse events.

Objective:To evaluate immunotherapy combined with neoadjuvant chemotherapy before radical total gastrectomy in microsatellite stable locally advanced gastric cancer in two cases.Methods:Two male patients with clinical stage cT3N 1M0 and microsatellite-stable locally advanced gastric cancer were treated with neoadjuvant chemotherapy with PD-1 inhibitor (Nivolumab) combined with SOX (Oxaliplatin+S-1) for 4 cycles before surgery. Standard laparoscopic assisted total gastrectomy with D 2 lymphadenectomy was performed on Feb 2023 and Oct 2023 respectively after the neoadjuvant treatment. Pathological tumor regression grade(TRG) was observed to assess the degree of tumor regression, and follow-up was conducted to monitor tumor markers and abdominal enhanced CT to detect recurrence. Results:Two patients achieved pathological complete response(TRG0). They were followed up until May 2024 and no recurrence was observed.Conclusion:Preoperative combination of chemotherapy and immunotherapy may provide survival benefit for microsatellite stable locally advanced gastric cancer patients.

Circular RNAs(CircRNAs)are a class of non-coding RNAs with a covalently closed-loop structure,high stability,and tissue specificity,with the production mechanisms different from linear RNAs.Recent studies have discovered that some CircRNAs can encode proteins via cap-independent translation mechanisms such as internal ribosome entry site,N6-methyladenosine,and rolling loop translation.The encoded proteins regulate homologous linear proteins or downstream signaling pathways via protein bait or other mecha-nisms,thereby exerting biological functions.Studies have shown that CircRNAs play a role in various diseases,especially in tumor progression,proliferation,invasion,and metastasis and immune regulation.Therefore,by elucidating the expression and roles of proteins encoded by CircRNAs in tumorigenesis and development,this pa-per is expected to provide new tumor markers and potential targets for tumor diagnosis and treatment.

ObjectiveTo establish an ultra-high performance liquid chromatography-tandem triple quadrupole mass spectrometry（UHPLC-QqQ-MS） for determination of the active ingredients in Erdongtang， and to predict the targets and pathways of anti-insulin resistance action of this formula. MethodThe analysis was performed on an ACQUITY UPLC BEH C₁₈ column（2.1 mm×100 mm， 1.7 μm） with the mobile phase of 0.1% formic acid aqueous solution（A）-acetonitrile（B） for gradient elution（0-3 min， 90%-87%A； 3-6 min， 87%-86%A； 6-9 min， 86%-83%A； 9-11 min， 83%-75%A； 11-18 min， 75%-70%A； 18-19 min， 70%-52%A； 19-22 min， 52%A； 22-25 min， 52%-5%A； 25-27 min， 5%-90%A； 27-30 min， 90%A）. The contents of active ingredients in Erdongtang was detected by electrospray ionization（ESI） and multiple reaction monitoring（MRM） mode under positive and negative ion modes. On this basis， network pharmacology was applied to predict the targets and pathways of Erdongtang exerting anti-insulin resistance effect. ResultThe 20 active ingredients in Erdongtang showed good linear relationships within a certain mass concentration range， and the precision， stability， repeatability and recovery rate were good. The results of determination showed that the ingredients with high content in 15 batches of samples were baicalein（1 259.39-1 635.78 mg·L^-1）， baicalin（1 078.37-1 411.52 mg·L^-1）， the ingredients with medium content were mangiferin（148.59-217.04 mg·L^-1）， timosaponin BⅡ（245.10-604.89 mg·L^-1）， quercetin-3-O-glucuronide（89.30-423.26 mg·L^-1）， rutin（46.91-1 553.61 mg·L^-1）， glycyrrhizic acid（55.97-391.47 mg·L^-1）， neomangiferin（37.45-127.03 mg·L^-1）， nuciferine（0.89-63.48 mg·L^-1）， hyperoside（6.96-136.78 mg·L^-1）， liquiritin（30.89-122.78 mg·L^-1）， liquiritigenin（26.64-110.67 mg·L^-1）， protodioscin（58.57-284.26 mg·L^-1）， the ingredients with low content were wogonin（7.16-20.74 mg·L^-1）， pseudoprotodioscin（5.49-22.96 mg·L^-1）， ginsenoside Rb₁（7.31-23.87 mg·L^-1）， ginsenoside Rg₁（10.78-28.33 mg·L^-1）， ginsenoside Re（7.78-24.76 mg·L^-1）， ophiopogonin D（2.08-4.29 mg·L^-1）， methylophiopogonanone A（0.74-1.67 mg·L^-1）. The results of network pharmacology indicated that the mechanism of anti-insulin resistance exerted by Erdongtang might be related to the phosphatidylinositol 3-kinase/protein kinase B（PI3K/Akt） signaling pathway. ConclusionThe established UHPLC-QqQ-MS has the advantages of simple sample processing， strong exclusivity and high sensitivity， and can simultaneously determine the contents of the main ingredients from seven herbs in Erdongtang， which can lay the foundation for the development of Erdongtang compound preparations. The results of the network pharmacology can provide a reference for the mechanism study of Erdongtang in the treatment of type 2 diabetes mellitus.

Objective To explore the diagnostic value of serum ficolin-3(FCN3)and collagen triple helix repeat containing-1(CTHRC1)in non-small cell lung cancer(NSCLC)and their relationship with clinicopathological characteristics.Methods From July 2021 to August 2022,73 patients with NSCLC who were admitted to the our Hospital were selected as the study group,and 55 healthy people who came to our hospital for physical examination were regarded as the control group.the serum levels of FCN3 and CTHRC1 were measured by enzyme-linked immunosorbent assay(ELISA);Pearson method was applied to analyze the correlation of serum FCN3 and CTHRC1 levels in NSCLC patients;Logistic regression analysis was applied to analyze the influencing factors of NSCLC;the diagnostic value of serum FCN3 and CTHRC1 levels on the occurrence of NSCLC was analyzed by the ROC curve.Results The levels of serum FCN3 and CTHRC1 in the study group were obviously higher than those in the control group(P＜0.05);the levels of serum FCN3 and CTHRC1 were correlated with the degree of cancer cell differentiation,TNM stage and lymph node metastasis in NSCLC patients(P＜0.05);Pearson method analysis showed that there was a positive correlation between serum FCN3 and CTHRC1 levels in NSCLC patients(r=0.258,P=0.028);Logistic regression analysis showed that serum FCN3 and CTHRC1 were the influencing factors of NSCLC(P＜0.05);the area under the ROC curve of serum FCN3 and CTHRC1 levels in diagnosis of NSCLC was 0.869 and 0.810,respectively,the area under the ROC curve of NSCLC was 0.881,which were better than those of serum FCN3 and CTHRC1.Conclusion The levels of serum FCN3 and CTHRC1 in patients with NSCLC increase,which are related to the degree of cancer cell differentiation,TNM stage and lymph node metastasis,they are risk factor for NSCLC,and the combination of the two is more valuable in diagnosis of NSCLC.

With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Objective:To explore the influencing factors of arteriovenous graft (AVG) dysfunction in hemodialysis (HD) patients, and provide a basis for predicting the risk of dysfunction and prolonging the service time.Methods:Retrospective analysis was performed on the clinical and follow-up data of patients who underwent AVG surgery in Department of Vascular and Interventional Surgery, Nanfang Hospital, Southern Medical University from January 2013 to September 2018. The factors of AVG dysfunction were determined by statistical methods.Results:A total of 139 patients were enrolled, including 58 males (41.7%); the median age was 57; in which 83 patients (59.7%) developed AVG dysfunction within 24 months. Kaplan-Meier survival analysis showed that the primary patency rates were 76.1%, 56.8%, and 38.5% at 6, 12, and 24 months after the establishment of AVG. The results of Kaplan-Meier survival analysis showed that at 24 months after surgery, the risk of AVG dysfunction in elderly patients (>65 years old) was significantly higher than that of patients≤65 years old (Log-rank χ2=7.632, P=0.006); the risk of AVG dysfunction in patients with mean platelet volume (MPV)>10.1 fl was significantly higher than that of patients with MPV≤10.1 fl (Log-rank χ2=19.910, P<0.001); the risk of AVG dysfunction in patients with platelet distribution width (PDW)>11.4 fl was significantly higher than that of patients with PDW≤11.4 fl (Log-rank χ2=35.410, P<0.001); the risk of AVG dysfunction in patients with platelet-larger cell ratio (P-LCR)>24.8% was significantly higher than that of patients with P-LCR≤24.8% (Log-rank χ2=7.181, P=0.007). Multivariate Cox proportional risk regression analysis showed that high MPV (MPV>10.1 fl, HR=6.501, 95% CI 1.916-22.054, P=0.003), high PDW (PDW>11.4 fl, HR=3.625, 95% CI 1.957-6.714, P<0.001) and low P-LCR (P-LCR>24.8%, HR=0.145, 95% CI 0.045-0.470, P=0.001) were independent influencing factors for AVG dysfunction. The establishment of a functional prediction equation based on the above factors had a certain value in predicting the risk of AVG dysfunction in HD patients (likelihood ratio test: χ2=49.360, P<0.001). Conclusions:There are multiple factors that affect AVG dysfunction in HD patients, among which MPV, PDW and P-LCR levels may be the influencing factors for AVG dysfunction. Preoperative examination or postoperative comprehensive review of these factors during the follow-up period has certain directive significance for the prevention of AVG dysfunction.

Objective:To compare the clinical efficacy of transperitoneal robot assisted laparoscopic radical prostatectomy (RARP) versus extraperitoneal single port RARP.Methods:A retrospective analysis was perfoumed on 142 cases of RARP from July 2019 to June 2020 in Robotic Minimally Invasive Center of Sichuan Provincial People's Hospital, including 82 cases(Group A) , aged 70.0(65.6-78.0), undergoing transperitoneal RARP and 60 cases(Group B), aged 68.2 years old(60.1-79.2), undergoing extraperitoneal single port RARP. For group A, PSA was 12.9(5.6-64.0) ng/ml, with 26 cases of less than 10 ng/ml(31.7%), 40 cases of 10-20 ng/ml(48.8%), and 16 cases of more than 20 ng/ml(19.5%), the Gleason score was 7.2(6.0-10.0), with 14 cases(17.1%) of ≤6, 56 cases(68.3%) of 7, and 12 cases(14.6%) of ≥8, and the prostate volume was 61.3(29.0-112.0) ml. There were 49 cases with BMI≤25 kg/m 2, accounting for 59.8%, and 33 cases with BMI>25 kg/m 2, accounting for 40.2%. There were 17 cases(20.7%) of T 1, 44 cases(53.7%) of T 2 and 21 cases(25.6%) of T 3. The proportion of lymph node dissection was 17.1%, and 4 cases(4.9%)had a history of operation. For group B, the PSA was 12.2(1.0-42.6)ng/ml, with 20 cases (33.3%) of <10 ng/ml, 31 cases(51.7%)of 10-20 ng/ml, and 9 cases (15%) of >20 ng/ml. Gleason score was 7.1(6.0-9.0), with 12 cases (20.0%) of ≤6, 42 cases (70.0%) of 7, and 6 cases (10.0%)of ≥8. Prostate volume was 42.4(31.2-72.8)ml on average. There were 37 cases (61.7%) with BMI≤25 kg/m 2, and 23 cases (38.3%)with BMI >25 kg/m 2 . There were 17 cases(28.3%)of T 1, 32 cases(53.3%)of T 2 and 11 cases(18.3%)of T 3.The proportion of lymph node dissection was 11.7% and 4 cases (6.7%) had a history of operation.There was no statistically significant difference in term of age, PSA level, Gleason score, BMI, clinical stage, proportion of lymph node dissection or history of operation between the two groups( P>0.05), but there was statistically significant difference for prostate volume( P<0.05). All operations were performed by the same operator. Four different ways of bladder neck and urethral dissociation was selected according to the intraoperative conditions in Group A, include VIP style, T-shape incision style, VIP plus T-shape incision style or the style along the lateral side of the bladder neck. Small and single anterograde incision stripping of bladder neck was routinely performed in the Group B. Postoperative follow-up was performed to compare the operation time, intraoperative blood loss, bladder neck and urethral anastomosis time, postoperative hospital stay, postoperative exhaust time, postoperative complications, positive rate of surgical margin, indwelling time of urinary catheter, urinary continence satisfaction rate of immediately after operation, 3 months and 6 months after operation, wound healing and aesthetics. Results:All of the operations were successfully completed under robot-assisted laparoscopy, and there was no conversion to open surgery. The operation time was 56.0(45.0-112.0) min in the Group A and 65.4(55.5-96.8) min in the Group B, and there was no statistically significant difference( P>0.05). The intraoperative blood loss was 76.2(30.0-120.5) ml and 55.6(45.5-114.6) ml, respectively, and the difference was not statistically significant( P>0.05). The time of bladder neck urethral anastomosis was 18.9(12.6-25.6) min and 16.2(10.7-19.3) min, respectively, and the difference was not statistically significant( P>0.05). The postoperative hospital stay days were 9.3(8.0-16.0) d and 8.4(7.0-13.0) d, respectively, and the difference was not statistically significant( P>0.05). The postoperative exhaust time was 1.3(0.7-3.0) d and 3.4(2.0-7.0) d, respectively, and the difference was statistically significant( P<0.05). There was 1 case of anastomotic fistula with ureteral injury in Group A, and no serious complication in Group B, and the difference was not statistically significant( P>0.05). The number of positive surgical margin in the two groups was 13(15.9%)and 9(15.0%)respectively, and the difference was not statistically significant( P>0.05). The indwelling time of urinary catheter after operation was 9(7-21) d and 6(4-8) d, respectively, and the difference was statistically significant( P<0.05). The number of patients with satisfactory urinary continence immediately after surgery, 3 months and 6 months after surgery in the two groups were 8(9.8%), 51(62.2%), 62(75.6%) and 17(28.3%), 43(71.7%) and 54(90.0%), respectively. The differences were statistically significant( P<0.05). The total incision lengths in the two groups were 12.1(10.4-13.4) cm and 5.6(5.0-6.0) cm, respectively, and the difference was statistically significant( P<0.05). Conclusions:The extraperitoneal single port RARP is safe and feasible, and the postoperative effect is similar to that of transperitoneal RARP. It has the advantages of shorter recovery time, higher urinary continence satisfaction rate, neater and more beautiful incision. The long-term therapeutic effect needs further confirming by prospective study.