Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

Objective:To analyze the efficacy and feasibility of performing a new surgical procedure, tunnel esophagogastrostomy, to perform proximal gastrectomy.Methods:The study cohort comprised 10 consecutive patients who had undergone esophagogastrostomy by the tunnel technique in Jiangsu Cancer Hospital between October 2019 and July 2022. All patients were male. Their average age was (64.2±8.1) years and body mass index (25.5±3.2) kg/m2. Nine had upper gastric body adenocarcinoma, the remaining one having signet ring cell carcinoma. TNM staging of the tumors showed that seven were Stage IA, one Stage IB, one Stage IIA, and one Stage IIIA. Briefly, tunnel esophagogastrostomy is performed as follows: After performing a proximal gastrectomy, a rectangular seromuscular flap (3.0 cm × 3.5 cm) is created. The posterior esophageal wall is sutured to the gastric wall at the orad end of the seromuscular flap 5 cm from the stump with three to four stitches. Next, the stump of the esophagus is opened, the posterior esophageal wall is sutured to the gastric mucosa and submucosa, and the anterior esophageal wall is sutured to the full layer of the stomach. Finally, the caudad end of the seromuscular flap is closed. Data on surgical safety, postoperative morbidity, and postoperative reflux esophagitis were analyzed. All enrolled patients completed endoscopic follow-up 1 year and 2 years after surgery.Results:All procedures were completed. They comprised four cases of laparoscopic assisted surgery, four of DaVinci robotic surgery, and two of open surgery. The mean operation time was 212.7±33.2 mins, mean anastomosis time (51.6±5.3) minutes, mean tunnel preparation time (20.0±3.5) minutes, and mean operative blood loss (90.0±51.6) mL. The time to first postoperative passage of flatus was (64.8±11.5) hours. The mean hospital stay after surgery was (9.2±1.7) days. There were no postoperative complications above Clavien-Dindo Grade II. The mean preoperative Reflux Disease Questionnaire score was (3.3± 0.4) before the surgery, (3.8±1.0) 1 month postoperatively, and (3.3±0.4) 12 months postoperatively. All patients underwent endoscopic follow-up; no anastomotic stenoses were found. However, one patient had Grade A reflux esophagitis 1 year after surgery and another Grade B reflux esophagitis 2 years after surgery.Conclusion:Esophagogastrostomy by the tunnel technique is a safe and feasible means of performing proximal gastrectomy.

Objective:To understand the mediating role of resourcefulness between perceived stress and depression in primary caregivers of stroke patients.Methods:The primary caregivers of 311 inpatients with stroke in three Class Ⅲ Grade A hospitals in Yinchuan from December 2020 to August 2021 were selected by convenience sampling and investigated with the general information form, Resourcefulness Scale (RS) , Chinese Perceived Stress Scale (CPSS) and Self-Rating Depression Scale (SDS) . SPSS 25.0 and PROCESS were used to analyze the relationship between the three, and to explore the mediating role of resourcefulness between perceived stress and depression in the primary caregivers of stroke patients.Results:In this study, 311 questionnaires were distributed, 311 questionnaires were recovered, and 308 questionnaires were valid. The primary caregivers of stroke patients scored (24.98±6.38) for perceived stress, (83.98±12.85) for resourcefulness, and (44.35±8.40) for depression. Resourcefulness was negatively correlated with perceived stress and depression scores ( r=-0.313, -0.317; P <0.01) , and perceived stress was positively correlated with depression ( r=0.425, P<0.01) . The Bootstrap method further validated that resourcefulness played a partial mediating role between perceived stress and depression, and the mediating effect accounted for 14.95% of the total effect. Conclusions:Resourcefulness is a mediating variable between the perceived stress and depression of the primary caregivers of stroke patients, and resourcefulness plays a partial mediating role between perceived stress and depression.

Objective:To compare the comprehensive performance of three Varian on-board image (OBI) image systems (KV-CBCT, KV-planar and MV-EPID) and to explore the value of the combined application of these three systems in daily image-guided radiotherapy for nasopharyngeal cancer.Methods:KV-CBCT, KV-planar and MV-EPID scanning and registration were carried out in the left and right/abdominal and back/head and foot direction on human head and neck phantom. The set-up error, registration time, additional radiation dose and image quality of the three systems were compared by F-test.Results:KV-CBCT, kV-planar and MV-EPID were scanned for 55 times, respectively, and the set-up errors in the left and right/abdominal and back/head and foot direction of the three image-guided systems were (0.00±5.43)/(-0.02±5.49)/(0.02±5.58) mm, (0.04±5.49)/(0.02±5.56)/(0.02±5.54) mm, (0.02±5.22)/(0.11±5.34)/(-0.04±5.33) mm, respectively ( P=0.999, 1.000, 0.989). The average time consuming was (200±45) s, (120±36) s and (115±42) s; the additional radiation dose from low to high was kV-planar, KV-CBCT and MV-EPID; the image quality from low to high was MV-EPID, kV-planar and KV-CBCT. Conclusions:Three image-guided systems can meet the requirements of image-guided radiotherapy for nasopharyngeal cancer. Based on the overall performance of the three systems, 1 CBCT+ 4 kV planar per week is recommended and EPID should be used as a backup system in daily image-guided radiotherapy for nasopharyngeal cancer. This scheme makes full use of the high image quality of CBCT and the low radiation of kV planar to realize the regular detection of nasopharyngeal cancer volume change and the implementation of high-precision radiotherapy.

Sijunzi decoction (SJZD) is a Chinese classical formula to treat spleen qi deficiency syndrome (SQDS) and has been widely used for thousands of years. However, the quality control (QC) standards of SJZD are insufficient. Chinmedomics has been designed to discover and verify bioactive compounds of a variety of formula rapidly. In this study, we used Chinmedomics to evaluate the SJZD's efficacy against SQDS to discover the potential quality-markers (q-markers) for QC. A total of 56 compounds in SJZD were characterized in vitro, and 23 compounds were discovered in vivo. A total of 58 biomarkers were related to SQDS, and SJZD can adjust a large proportion of marker metabolites to normal level and then regulate the metabolic profile to the health status. A total of 10 constituents were absorbed as effective ingredients that were associated with overall efficacy. We preliminarily determined malonyl-ginsenoside Rb2 and ginsenoside Ro as the q-markers of ginseng; dehydrotumulosic acid and dihydroxy lanostene-triene-21-acid as the q-markers of poria; glycyrrhizic acid, isoglabrolide, and glycyrrhetnic acid as the q-markers of licorice; and 2-atractylenolide as the q-marker of macrocephala. According to the discovery of the SJZD q-markers, we can establish the quality standard that is related to efficacy.

Objective:To investigate relationships between social support and dysfunctional cognition, personality disorder in patients with somatoform disorder.Methods:One hundred and four patients with somatoform disorders and 97 healthy subjects were evaluated with the Social Support Rating Scale (SSRS), Dysfunctional Attitudes Scale (DAS) and Personality Diagnostic Questionnaire (PDQ-4). Social support ratings were compared between patients and healthy controls.The relationship between social support and dysfunctional cognition, personality disorder were analyzed.Results:The scores of social support in all dimensions of patients with somatoform disorder(total score of social support(37.18±8.12), objective social support(8.49±2.83), subjective social support(21.90±5.44), social support utilization(6.79±1.85)) were significantly lower than those in the healthy control group(total score of social support(41.82±6.87), objective social support(9.92±3.38), subjective social support(24.32±4.25), social support utilization(7.59±1.31))( P<0.05). In patients with somatoform disorder, there was a significant negative correlation between the total score of SSRS and the scores of DAS ( r=-0.245, P<0.05) and personality disorder tendency ( r=-0.292, P<0.01). Social support utilization had a significant predictive effect on dysfunctional cognition ( B=-5.384, P=0.007). Conclusion:Social support of patients with somatoform disorder is correlated with dysfunctional cognition and personality disorder tendency, which provides the basis for psychological intervention such as group and family psychotherapy.

Objective: To analyze the impact of dual antiplatelet (DAPT) therapy combining with or without proton pump inhibitors (PPI) on the main outcomes after percutaneous coronary intervention (PCI). Methods: The PubMed, EMBASE and Cochrane Library were searched for relevant literature and the references obtained from these sources were retrieved manually from inception till September 2017. Inclusion and exclusion criteria were established follow the Cochrane review standard. A total of 977 literatures were included, 193 duplicates were excluded, 74 reviews, case reports, letters and systematic reviews were excluded, 667 literatures were excluded after reading the title and abstract, 34 literatures were excluded due to non-randomized control studies and unrelated outcome indicators, and 9 literatures were finally included with a total of 16 589 patients. RevMan 5.3 software was used to compare the incidence of major adverse cardiovascular events (MACE), cardiogenic death, recurrent myocardial infarction, target vessel revascularization, all-cause death, stent thrombosis, stroke, gastrointestinal bleeding and gastrointestinal events in patients with DAPT combining with or without PPI after PCI. Results: MACE was observed in 8 out of the 9 included literatures, and the results showed that MACE occurred in 561 out of 6 282 patients receiving DAPT combining with PPI therapy and in 951 out of 9 632 patients using DAPT alone (OR=1.15, 95%CI 0.88-1.51, P>0.05). Cardiogenic death was observed in 7 out of the 9 included literatures, and the results showed that cardiogenic death occurred in 172 out of 6 453 patients receiving DAPT combining with PPI treatment and in 321 out of the 9 839 patients using DAPT alone (OR=0.97, 95%CI 0.80-1.18, P>0.05). Recurrent myocardial infarction was observed in 7 out of the 9 included literatures, the results showed 416 out of 6 282 cases in DAPT combining with PPI therapy group experienced recurrent myocardial infarction and 691 out of 9 632 cases in DAPT group experienced recurrent myocardial infarction (OR=1.01, 95%CI 0.89-1.16, P>0.05). Four out of 9 literatures observed revascularization. The results showed that revascularization was performed in 64 out of 2 173 patients receiving DAPT combining with PPI therapy and in 105 out of the 2 770 patients using DAPT alone (OR=1.33, 95%CI 0.55-3.24, P>0.05). All-cause death was observed in 7 out of the 9 included literatures, and the results showed that all-cause death occurred in 172 out of the 6 453 patients in DAPT combining with PPI therapy group and in 321 out of the 9 839 patients using DAPT alone (OR=0.97, 95%CI 0.80-1.18, P>0.05). Three out of the 9 included articles observed stent thrombosis, and the results showed that stent thrombosis occurred in 99 out of 2 997 patients receiving DAPT combining with PPI therapy and in 245 out of the 6 198 patients treated with DAPT (OR=1.07, 95%CI 0.83-1.37, P>0.05). Stroke was observed in 2 out of the 9 included literatures. The results showed that stroke occurred in 5 out of 2 019 patients receiving DAPT combining with PPI therapy, and in 4 out of the 2 033 patients treated with DAPT (OR=1.00, 95%CI 0.29-3.49, P>0.05). Gastrointestinal bleeding was observed in 6 out of the 9 included literatures. The results showed that gastrointestinal bleeding occurred in 26 out of 3 517 patients receiving DAPT combined with PPI therapy, and in 93 out of the 3 506 patients treated with DAPT, gastrointestinal bleeding was significantly lower in the DAPT combining with PPI group than DAPT alone group (OR=0.27, 95%CI 0.17-0.41, P<0.01). Gastrointestinal events were reported in 6 out of the 9 included articles. Similarly, gastrointestinal events were observed in 51 out of 3 517 patients receiving DAPT combined with PPI therapy, and in 190 out of the 3 506 patients treated with DAPT alone, the incidence of gastrointestinal events in the DAPT combined with PPI group was significantly lower than DAPT alone group (OR=0.24, 95%CI 0.14-0.42, P<0.01). Conclusions The incidence of MACE, cardiogenic death, recurrent myocardial infarction, target vessel revascularization, all-cause death, stent thrombosis and stroke are not affected by DAPT combined with PPI therapy after PCI, while the incidence of gastrointestinal bleeding and gastrointestinal events could be reduced by adding PPI to DAPT in patients undergoing PCI.

Objective To examine the characteristics of dysfunctional attitudes in patients with so?matoform disorders and to delineate the relationship between dysfunctional attitudes and personality disorder tendency. Methods Sixty?four outpatients with somatoform disorder and 52 healthy individuals were recrui?ted and asked to complete the Personality Diagnostic Questionnaire( PDQ?4) and the Dysfunctional Attitudes Scale( DAS ) for the evaluation of their personality disorder tendency and cognitive characteristics. DAS scores were compared between patient and control groups. The relationship between DAS and PDQ?4 was e?valuated by comparing DAS scores of patients with and without personality disorder tendency and by correla?ting patients’ total scores of DAS and PDQ?4. Results Patients with somatoform disorder(150.13±31.75) showed significantly higher scores of DAS than healthy controls(121.62±20.30). Moreover,patients with per?sonality disorder tendency exhibited significantly higher scores in the total score of DAS and scores of five factors including vulnerability, absorption/exclusive, compulsion, dependence and cognitive philosophy ( P<0.05) . Finally,a positive correlation was found between total scores of DAS and PDQ?4( r=0.535, P<0.01) and the correlation coefficients between the total score of DAS and Cluster A( r=0.545) and C scores( r=0.625) were significantly higher than that of Cluster B score( r=0.317).Conclusion Patients with somato?form disorders have cognitive distortion,which is correlated with personality disorder tendency.

Objective To investigate the clinical significance of precursor of gastrin‐releasing peptide(ProGRP) for the differen‐tial diagnosis between small cell lung cancer (SCLC) and non‐small cell lung cancer(NSCLC) and efficacy assessment .Methods The levels of ProGRP were detected by ELISA in 210 healthy adults ,200 patients with lung benign disease ,260 patients with NSCLC and 182 patients with SCLC before treatment and after chemotherapy .Results The level of ProGRP in the SCLC group was significantly higher than that in the NSCLC group ,healthy control group and lung benign disease group(P<0 .01) .The sensi‐tivity of ProGRP for detecting SCLC was 56 .3% and the specificity was 92 .6% .When combination detection of ProGRP and NSE was used ,the sensitivity increased to 82 .6% ;the level of ProGRP in the patients with SCLC after 2‐cycle chemotherapy was signifi‐cantly lower than before treatment (P<0 .01) .Conclusion The tumor marker ProGRP has very important guidance significance to assisted diagnosis ,differential diagnosis and efficacy assessment of chemotherapy in the patients with SCLC .

OBJECTIVE: To investigate the clinical application value of cone-beam CT (CBCT) online correcting technology in volume modulated radiation therapy (VMRT) for nasopharyngeal carcinoma (NPC). METHOD: Fifty NPC patients applying head neck and shoulder thermoplastic body membrane fixing device were eligible for treatment VMRT, these patients would accept a couple of CBCT scanning by on board imager (OBI) in a fixed time each week after initial setup and after online correcting during the first three week for radiotherapy, CBCT images and DRR images constructed by CT simulation were carried out registration,which could calculate the setup errors of initial setup and after online correcting. RESULT: Fifty patients were accepted 150 scanning after initial setup and 150 scanning after online correcting respectively, the errors after initial setup were (-1.24 ± 1.25)mm in X direction, (1.19 ± 1.85)mm in Y direction, (1.49 ± 1.70) mm in Z direction. The setup errors after online correcting were (-0.13 ± 0.29)mm in X direction, (0.10 ± 0.47)mm in Y direction, (0.17 ± 0.36)mm in Z direction. The setup errors after online correcting were significantly lower than the errors after initial setup in X direction (P < 0.05), Y direction (P < 0.05), Z direction(P < 0.05). The M(PTV) value after online correcting were 0.46 mm, 0.53 mm and 0.59 mm in X, Y and Z directions respectively. CONCLUSION The use of CBCT online correcting technology can significantly reduce the setup errors of VMRT for NPC and improve the treatment effect.
Carcinoma ; Cone-Beam Computed Tomography ; Humans ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Intensity-Modulated