Objective: To Summarize the safety, clinical outcome and technical evolution of laparoscopic gastric cancer surgery. Methods: A retrospective cohort study was carried out. Clinical data of 3012 patients who underwent laparoscopic radical gastrectomy for gastric cancer from January 2010 to March 2022 at Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University were retrospectively collected and analyzed. Case inclusion criteria were gastric malignancies confirmed by pathology, without distant metastasis by examination before operation and exploration during operation, patients undergoing laparoscopic radical gastrectomy, intact function of important organs and with complete data. Exclusion criteria were patients who underwent emergency gastric cancer resection due to gastric bleeding, perforation or obstruction, etc., tumor found to invade adjacent organs such as pancreas or transverse colon during the operation, conversion to open surgery during the operation, those who had other malignant tumors (except thyroid cancer) within 5 years, and those had severe cardiopulmonary, liver, or kidney insufficiency before surgery. Outcomes included: (1) baseline information of patients; (2) trend of the quantity of laparoscopic radical gastrectomy year by year; (3) evolution of the mode of digestive tract reconstruction; (4) periopertive outcome short-term complication was defined as complication occurring within 30 days after operation and classified accordiny to the clavien-Dindo criteria; and (5) 5-year overall survival. SPSS software was used for statistical analysis. Continuous variables that obeyed the normal distribution were expressed in the form of Mean±SD. Days of hospital stay that did not follow a normal distribution were expressed as median (Q₁,Q₃), and the Mann-Whiney U test was used for comparison. Discrete variables were expressed as cases (%), and chi-square test or rank sum test was used for comparison between groups. Linear regression analysis was used to analyze the relationship between the amount of surgery and the year of surgery. Kaplan-Meier method and log-rank test were used for survival analysis. Two-tailed P<0.05 was considered as statistically significant. Results: Among the 3012 cases, 2114 were male and 898 were female. The patients' average age at surgery was (61.1±10.7) years old. According to the number of cumulative cases, the patients were divided into three groups: early, intermediate and late, with 1004 patients in each group. The early group consisted of patients undergoing operation from January 2010 to October 2018, the intermediate group consisted of patients undergoing operation from October 2018 to January 2021, and the late group consisted of patients undergoing operation from January 2021 to March 2022. (1) General information: There were 691 (68.8%), 699 (69.6%) and 724 (72.1%) male patients in early, intermediate and late groups respectively; the average age increased from 56.6 years in 2010 to 62.8 years in March 2022. As for the tumor stage T1, T2, T3, T4, there were 49.0%, 14.4%, 23.9% and 12.6% in the early group; 47.5%, 12.9%, 26.9% and 12.6% in the intermediate group; 39.7%, 14.6%, 30.0%, and 15.6% in the late group, respectively. Patients with N0, N1, N2, N3a, N3b stage were 56.8%, 13.7%, 13.4%, 11.0%, and 5.0% in the early group; 55.7%, 12.9%, 12.8%, 11.6%, and 6.9% in the intermediate group; 51.0%, 16.1%, 12.8%, 12.5%, and 7.5% in the late group, respectively. (2) Year-by-year change in the number of gastric cancer operations: From 19 cases per year in 2010 to 786 per year in 2021, the annual number of gastric cancer operations was proportional to the year of operation (y=47.505x, R²=0.67). The proportion of patients with stage I disease showed a fluctuating downward trend over time, while the proportion of patients with stage III disease increased slightly, accounting for 34% until March 2022. (3) Evolution of digestive tract reconstruction methods: Except in 2010, the digestive tract reconstruction method of distal gastrectomy focused on Billroth-II+Braun anastomosis among patients undergoing laparoscopic gastric cancer surgery in other years, whose proportion had gradually increased from less than 20% in 2016 to about 70% after 2021; the gastrointestinal reconstruction methods after total gastrectomy had gradually increased in π anastomosis and overlap anastomosis since 2016, of which π anastomosis reached about 65% in 2019, and overlap anastomosis reached almost 30% in 2020; the anastomosis methods after proximal gastrectomy had been mainly double-channel anastomosis (54%) and esophagogastric anastomosis (30%) since 2016, and double-channel anastomosis accounted for up to 70% in 2019. (4) Operation time: The operation time of early, intermediate and late group was (193.3±49.8) min, (186.9±44.3) min and (206.7±51.4) min respectively. Intermediate group was significantly shorter than early group (t=3.005, P=0.003), while late group was significantly longer than early group (t=5.875, P<0.001) and intermediate group (t=9.180, P<0.001). (5) Postoperative hospital stay: The median length of hospital stay for gastric cancer patients in early, intermediate and late groups was 9 (8, 11) d, 8 (7, 10) d, and 8 (7.5, 10) d respectively. The postoperative hospital stay of intermediate group and late group was significantly shorter than that of early group (Z=-12.467, Z=-5.981, both P<0.001), but there was no significant difference between intermediate group and late group (Z=0.415,P=0.678). (6) Postoperative complication: The morbidity of short-term complication in early, intermediate and late group was 20.4% (205/1004), 16.2% (163/1004), and 16.2% (162/1004) respectively, and above morbidity of intermediate group and late group was significantly lower than that of early group (χ²=5.869, P=0.015; χ²=6.165, P=0.013), while there was no significant difference between intermediate group and late group (χ²=0.004,P=0.952). The morbidity of short-term complication of grade IIIor higher was 8.0% (80/1004), 7.6% (76/1004), and 4.9% (49/1004) in early, intermediate and late group respectively, and above morbidity of late group was significantly lower than that of early and intermediate group (χ²=7.965, P=0.005; χ²=6.219,P=0.013), while there was no significant difference between intermediate group and early group (χ²=0.111,P=0.739). (7) Survival analysis: The follow-up deadline for survival data was December 31, 2021, and the median follow-up time was 29.5 months. The overall 5-year survival rate of all the patients was 74.7%. The 5-year survival rates of stage I, II and III patients were 92.0%, 77.2%, and 40.3% respectively and 5-year survival rates of patients with stage IA, IB, IIA, IIB, IIIA, IIIB and IIIC were 93.2%, 87.8%, 81.1%, 72.7%, 46.2%, 37.1%, and 34.0% respectively. Conclusions: The number of laparoscopic gastric cancer operation in our center is increasing year by year. With the maturity of laparoscopic technology, the morbidity of complication in laparoscopic gastric cancer surgery is decreasing.
Aged ; Data Analysis ; Female ; Gastrectomy/methods* ; Humans ; Laparoscopy/methods* ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms/surgery* ; Treatment Outcome

BACKGROUNDReactive oxygen species are thought to contribute to the development of renal damage. The P22phox subunit of nicotinamide adenine dinucleotide phosphate (NAPDH) oxidase, encoded by the cytochrome b245a polypeptide gene, CYBA, plays a key role in superoxide anion production. We investigated the association of CYBA rs7195830 polymorphism with estimated glomerular filtration rate (eGFR) and the role it plays in the pathogenesis of chronic kidney disease (CKD) in a Han Chinese sample.

METHODSThe Gaoyou study enrolled 4473 participants. Serum levels of creatinine were measured and eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equations. The CYBA polymorphisms were genotyped. Then we investigated the association between eGFR and the rs7195830 polymorphism in the recessive model.

RESULTSThe AA genotype of rs7195830 was associated with significantly lower values of eGFR compared with the GG and AG genotypes ((102.76 ± 17.07) ml×min(-1)×1.73 m(-2) vs. (105.08 ± 16.30) ml×min(-1)± 1.73 m(-2)). The association remained significant in the recessive model after adjusting for age, gender, body mass index, smoking, hypertension, diabetes mellitus, uric acid, triglyceride, low density lipoprotein cholesterol and high density lipoprotein cholesterol (β=1.666, P=0.031). The rs7195832 AA genotype was an independent risk factor for CKD: eGFR <60 ml×min(-1)×1.73 m(-2) (odds ratio=3.32; 95% CI=1.21-9.13).

CONCLUSIONThe AA genotype of rs7195830 is independently associated with lower estimated glomerular filtration rate and is significantly associated with CKD.

Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; genetics ; Female ; Glomerular Filtration Rate ; genetics ; Humans ; Male ; Middle Aged ; NADPH Oxidases ; genetics ; Polymorphism, Genetic ; genetics ; Renal Insufficiency, Chronic ; epidemiology ; genetics ; Young Adult

The repellent activity of α-pinene, β-pinene, and twenty four terpenoids derived from α-pinene or β-pinene against Germen cockroaches, Blattella germanica, were tested with dipped filter paper.Twenty of the tested compounds showed positive repellent activity at the concentration of 20 mg/mL.Menthol held the most powerful activity with the repellent rate of 68.9%, demonstrating its promising prospect in cockroach control.Three-dimensional structure of twenty-six terpenoid compounds were built and optimized by GAUSSIAN software.Descriptors for those structures were calculated from AMPAC and CODESSA software.Descriptors screening and the quantitative structure-activity relationship ( QSAR) building were carried out by applying heuristic approach in CODESSA software.The optimal model with correlation coefficient R2 of 0.7923 was obtained.The model, i.e.Repellent rate (%) Y=269.13+15.36X1 -77.16X2 +0.83X3+1.38X4 +0.83X5 +2.58X6, shows that six principal activity-affecting parameters X1, X2, X3, X4, X5 and X6 were Max atomic state energy for a H atom, FPSA-3 Fractional PPSA (PPSA-3/TMSA), Tot hybridization comp.of the molecular dipole, Max atomic state energy for a C atom, ESP-FNSA-2 Fractional PNSA ( PNSA-2/TMSA) and Image of the Onsager-Kirkwood solvation energy respectively.

Objective To investigate the relationship between c-reactive protein (CRP) and blood pressure in a general population. Methods We randomly selected 3889 subjects aged 18 -74 years stratified by gender and age in Baqiao, a rural area of Jiangsu Province. A standardized questionnaire was used to collect information on medical history, smoking, alcohol intake and use of medications. Blood pressure was measured by mercury sphygmomanometer. Serum CRP (hCRP) concentration was measured using a high sensitivity BNprosec immunonephelometric assay. Subjects were divided into 4 groups according to their interquartile range of CRP levers: group Q1 ( men hCRP ＜2. 04 mg/L;women hCRP ＜ 1.80 mg/L);group Q2 ( men 2. 04 mg/L ≤ hCRP ＜ 3.01 mg/L; women 1.80 mg/L ≤ hCRP ＜ 2. 76 mg/L); group Q3(men 3.01 mg/L≤ hCRP ＜4. 14 mg/L;women 2.76 mg/L ≤ hCRP ＜3. 84 mg/L);and group Q4(men 4. 14 mg/L≤hCRP;women 3. 84 mg/L ≤ hCRP). Results Systolic blood pressure ( SBP, adjusted P =0. 016 ) and pulse pressure ( PP, adjusted P =0. 003 ) of men and PP ( adjusted P =0. 002) of women were increased in proportion to increased CRP levels. Diastolic blood pressure was not associated with CRP levels. Multiple stepwise regression analysis showed that logCRP was independently associated with SBP and PP in men and PP in women. hCRP was independently associated with hypertension in men. Compared with group Q1, male people in group Q4 faced a40. 4% (95% confidence interval:4. 9% -87.9% ) higher risk of hypertension. Conclusions hCRP was independently associated with PP in men and women, and SBP in men. hCRP was independently associated with hypertension in men but not in women in this study population.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; External Fixators ; adverse effects ; Female ; Fracture Fixation ; methods ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery

OBJECTIVETo demonstrate that estrogen stimulates the angiogenesis of children' s hemangioma.

METHODSA piece of hemangioma biopsy was embedded in fibrin gel, and a model in vitro of angiogenesis of human hemangioma was then established. The angiogenesis of hemangioma in each group was interfered by the estrogen and tamoxifen. There were four groups divided into the followings: the group with estrogen, the group with tamoxifen, the group with estrogen + tamoxifen and the control. The dimension of newborn tubule area in the 3rd, 6th, 9th day after the culture was calculated to compare statistically differences among the groups.

RESULTSIn the model of angiogenesis of hemangioma, microvessels grew out from the tissue sample in 2 to 3 days after the culture, and in 8 to 9 days a complex network of microvessels had been shown, the tending to inactivity. On the 3rd,6th and 9th day after the culture the dimension of newborn tubule area of the group of estrogen [(2.84 +/- 0.20) mm2 (12.93 +/- 0.85) mm2 (22.47 +/- 1.40) mm2] were larger than those of the control [(1.98 +/- 0.17) mm2, (7.51 +/- 0.48) mm2, (11.26 +/- 0.73) mm2]. Those of the group of estrogen + tamoxifen [(1.08 +/- 0.11) mm2, (3.54 +/- 0.31) mm2, (5.72 +/- 0.40 mm2] and the group of tamoxifen [(1.13 +/- 0.14) mm2 (4.26 +/- 0.29) mm2, (6.08 +/- 0.42) mm2] were smaller than those of the groups of the estrogen and the control (P < 0.05).

CONCLUSIONSThe estrogen may stimulate the angiogenesis of children's hemangioma, and the tamoxifen may reverse the process.

Child ; Estrogens ; adverse effects ; Hemangioma ; pathology ; Humans ; In Vitro Techniques ; Neovascularization, Pathologic ; pathology

OBJECTIVETo create a three dimension (3D) in vitro model for angiogenesis of hemangioma.

METHODThe fragment of hemangioma specimen was embedded in fibrin gel to set up the three-dimension (3D) in vitro model for angiogenesis of hemangioma.

RESULTIn the model, microvessels grew out from the tissue fragments at the 2nd to 3rd day after culture, and at the 8th to 9th day a compact network of microvessels come into being, then tending to be stationary. The compact network around the tissue fragment was confirmed to be blood vessels by immunohistochemistry and electron microscopy.

CONCLUSIONThis model helps to study the mechanism of hemangioma angiogenesis and investigate the drugs of anti-angiogenesis.

Cells, Cultured ; Endothelium, Vascular ; Hemangioma ; Humans ; Models, Cardiovascular ; Neovascularization, Pathologic

OBJECTIVETo investigate the application of the island flap based on the postfemur neurocutaneous nutrient vessel.

METHODSThe flap was designed and applied to repair the defects in the gluteal, popliteal fossa or the bilateral postfemur areas. A total of 11 cases (12 defects) were treated with this method. The size of the defects ranged from 4.0 cm x 7.8 cm to 8.3 cm x 16.6 cm.

RESULTSOf the 12 defects, 9 achieved complete success. Epidermal necrosis occurred in the distal part of the flap in 3 defects owing to venous stasis, which were cured with skin grafting. Postoperative follow-up for 8-19 months showed that the appearance, texture, and function of the flap were satisfactory.

CONCLUSIONSThe advantages of the flap lie in the reliable blood supply, constant anatomy, and without sacrificing a major artery. The key points for the flap survival are utilizing the "Superficial vein-nutrient vessel of the cutaneous nerve system" and retaining a comet tail-shaped soft-tissue pedicle in the flap creation.

Arteries ; Follow-Up Studies ; Humans ; Necrosis ; etiology ; surgery ; Skin ; injuries ; pathology ; Skin Transplantation ; Surgical Flaps ; blood supply ; pathology ; transplantation ; Thigh ; Wound Healing