Gastric cancer,a malignant tumor with high morbidity and mortality in China,has characteristics such as high heterogeneity and poor prognosis.With the advent of the 21st century,significant progress has been made in gastric cancer diagnosis and treatment due to the rapid development of genomics,laparoscopic minimally invasive techniques,targeted therapy and immunotherapy.This article summarized the important research progress in the field of gastric cancer prevention and treatment since the 21st century,and looked forward to the future.We hope to make greater progress and breakthroughs in early screening,diagnosis and precise treatment of gastric cancer,further improve the overall survival rate of patients,and transform gastric cancer into a controllable"chronic disease".

Background and purpose:Follow-up data of 6 737 patients undergoing surgery for gastric cancer were collected based on hospital registration,and the 1-,3-and 5-years observed overall survival(OS)rates and disease-free survival(DFS)rates were analyzed to provide real-world research evidence for the prevention and control of gastric cancer and policy making in China.Methods:A total of 6 737 gastric cancer patients who underwent surgical treatment at Fudan University Shanghai Cancer center from 2015 to 2020 were included in this study.Clinical information and the follow-up endpoint data were collected through medical records review,telephone visits and death registry data linkage.The last follow-up date was November 30,2023.Kaplan-Meier method was applied in evaluating the 1-,3-and 5-year OS rate and DFS rate,and survival data were described by different subgroups including age group,gender,treatment period,tumor staging,and pathological characteristics.Results:With a median follow-up time of 50.99 months,the 5-year OS rate of surgically resected gastric cancer patients was 70.37%,and 5-year DFS rate in Ⅰ-Ⅲ stage cases was 69.46%.The 5-year OS rates of stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 94.32%,82.56%,51.01%and 23.97%,respectively.The differences in survival among patients with different age,tumor location,gross classification,Borrmann classification and Laurence classification were significant.Conclusion:Staging is an important factor directly affecting the survival of gastric cancer patients.Screening and early diagnosis and treatment in large population,especially high-risk group,should be strengthened to further improve the patients'survival.

Objective     To compare the effects of anterior mediastinal tumor resection by the Da Vinci robot and video-assisted thoracoscopy via subxiphoid approach. Methods     A retrospective cohort study was conducted to continuously enroll patients who underwent anterior mediastinal tumor resection between 2020 and 2021 in our department. They were divided into a robotic group and a subxiphoid thoracoscopic group. The differences of general indexes (intraoperative blood loss, postoperative drainage volume, postoperative catheterization time, postoperative hospital stay), postoperative pain visual analogue scale (VAS), perioperative declining levels of hemoglobin, hematocrit, serum prealbumin and serum albumin were compared and analyzed. Results     A total of 113 patients were enrolled. There were 76 patients in the robotic group (46 males and 30 females, median age of 50 years) and 37 patients in the subxiphoid thoracoscopic group (21 males and 16 females, median age of 51 years). Intraoperative blood loss, postoperative drainage volume, postoperative catheterization time and postoperative hospital stay of the robotic group were better than those in the subxiphoid thoracoscopic group (P<0.05). The postoperative VAS scores in the robotic group were lower than those in the subxiphoid thoracoscopic group, but there was no statistical difference (P>0.05). Perioperative declining levels of hemoglobin, and hematocrit were not statistically different between the two groups (P>0.05). Declining levels of serum prealbumin, and serum albumin in the robotic group were lower than those in the subxiphoid thoracoscopic group (P<0.05). Conclusion     Da Vinci robotic and subxiphoid video-assisted thoracoscopic surgeries for the treatment of anterior mediastinal tumors are both safe and reliable, with short postoperative hospital stay, mild postoperative pain and quick recovery. Da Vinci robot surgery has a slight advantage in the treatment outcome.

Objective    To compare and analyze the therapeutic effects of robot-assisted lobectomy and segmentectomy for stage ⅠA non-small cell lung cancer with a diameter≤2 cm. Methods    A total of 181 patients with pathologically confirmed stage ⅠA non-small cell lung cancer (diameter≤2 cm) who underwent robot-assisted lobectomy and segmentectomy in our hospital from 2018 to 2021 were included. There were 74 males and 107 females with an average age of 57.50±10.60 years. They were divided into two groups according to the surgical procedure: a segmentectomy group (85 patients) and a lobectomy group (96 patients). Results    There was no statistically significant  difference between the two groups in terms of clinical data such as age, gender, smoking history, basic disease, pathological type, tumour diameter, operative time, postoperative 24 h drainage volume and overall complications (P>0.05). The intraoperative blood loss (33.88±16.26 mL vs. 39.27±19.48 mL, P=0.046), groups of dissected lymph nodes (4.76±1.19 vs. 5.52±1.46, P=0.000), number of dissected lymph nodes (14.81±7.23 vs. 18.06±7.70, P=0.004) and postoperative 72 h drainage volume (561.65±225.31 mL vs. 649.84±324.34 mL, P=0.037) of patients in the segmentectomy were less than those in the lobectomy group. The chest drainage time (5.49±3.92 d vs. 7.60±4.96 d, P=0.002) and postoperative hospital stay time (7.47±4.16 d vs. 9.67±5.50 d, P=0.003) were shorter than those in the lobectomy group. There was no conversion to thoracotomy or perioperative death in the two groups. The postoperative follow-up rate was 100.0% with a longest follow-up time of 48 months. The 3-year recurrence-free survival rates of the segmentectomy group and lobectomy group were 87.7% and 92.4%, respectively (P=0.465). Conclusion    The da Vinci robot-assisted lobectomy and segmentectomy are safe and feasible surgical procedures for patients with stage ⅠA non-small cell lung cancer (diameter≤2 cm), with a similar 3-year recurrence-free survival rate. The lobectomy group has more lymph nodes dissected, while the segmentectomy group is superior to the lobectomy group in terms of intraoperative blood loss, postoperative 72 h chest drainage volume, chest drainage time and postoperative hospitalization time.

Objective     To compare the short- and long-term survival of patients with stage T1N0M0 non-small cell lung cancer (NSCLC) undergoing robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS). Methods     The clinical data of 396 patients with stage T1N0M0 NSCLC treated with RATS or VATS in our hospital from 2012 to 2019 were retrospectively analyzed. There were 209 males and 187 females, with a mean age of 61.58±8.67 years. According to surgical procedures, they were separated into two groups: a RATS group (n=157) and a VATS group (n=239). The two groups were compared in terms of the survival and prognosis-influencing factors. Results     The intraoperative blood loss and postoperative 24 h drainage volume in the RATS group were less than those  in the VATS group (48±42 mL vs. 182±231 mL, P<0.001; 250±119 mL vs. 324±208 mL, P<0.001). The groups and number of dissected lymph node in the RATS group were more than those of the VATS group (5±2 groups vs. 3±2 groups, P<0.001; 17±9 vs. 11±8, P<0.001). There was no statistical difference in the postoperative 48 h drainage volume (P=0.497), postoperative intubation time (P=0.180) or hospital stay (P=0.313). The survival state and recurrence-free survival state in the VATS group were better than those in the VATS group (1-year survival rate: 98.7% vs. 94.8%, 5-year survival rate: 90.5% vs. 75.8%, 8-year survival rate: 76.9% vs. 62.1%, mean survival time: 93 months vs. 79 months, P=0.005; 1-year recurrence-free survival rate: 97.4% vs. 95.6%, 5-year recurrence-free survival rate: 94.8% vs. 77.8%, 8-year recurrence-free survival rate: 82.6% vs. 64.8%, mean recurrence-free survival time: 95 months vs. 79 months, P=0.004). Univariate analysis showed that surgical method, the groups and the number of dissected lymph nodes were the influencing factors for postoperative overall survival and recurrence-free survival. At the same time, the results of multivariate analysis showed that surgical method was a common independent factor for overall survival and recurrence-free survival. Conclusion     RATS can obtain better survival in patients with T1N0M0 NSCLC, and RATS has more thorough lymph node dissection, less intraoperative blood loss and postoperative 24 h drainage volume.

Purpose: Tumor recurrence is the principal cause of poor outcomes in remnant gastric cancer (RGC) after resection. We sought to elucidate the recurrent patterns according to tumor locations in RGC. Materials and Methods: Data were collected from the Shanghai Cancer Center between January 2006 and December 2020. A total of 129 patients with RGC were included in this study, of whom 62 had carcinomas at the anastomotic site (group A) and 67 at the non-anastomotic site (group N). The clinicopathological characteristics, surgical results, recurrent diseases, and survival were investigated according to tumor location. Results: The time interval from the previous gastrectomy to the current diagnosis was 32.0±13.0 and 21.0±13.4 years in groups A and N, respectively. The previous disease was benign in 51/62 cases (82.3%) in group A and 37/67 cases (55.2%) in group N (P=0.002). Thirty-three patients had documented sites of tumor recurrence through imaging or pathological examinations. The median time to recurrence was 11.0 months (range, 1.0–35.1 months). Peritoneal recurrence occurred in 11.3% (7/62) of the patients in group A versus 1.5% (1/67) of the patients in group N (P=0.006). Hepatic recurrence occurred in 3.2% (2/62) of the patients in group A versus 13.4% (9/67) of the patients in group N (P=0.038). Patients in group A had significantly better overall survival than those in group N (P=0.046). Conclusions The tumor location of RGC is an essential factor for predicting recurrence patterns and overall survival. When selecting an optimal postoperative follow-up program for RGC, physicians should consider recurrent features according to the tumor location.

Objective To investigate the medication adherence of military academy students with superficial mycoses. Methods A 8-item Morisky medication adherence scale (MMAS) was modified into 7-item scale to evaluate the compliance of antifungal drugs in the sick students. The reliability and validity of the scale were analyzed. Results A total of 243 questionnaires were collected, of which 242 were valid questionnaires. 90.08% of the students took topical medication and 8.68% were treated both with topical and systematic combination. High, medium and low medication adherence rates as assessed by the modified MMAS were 9.09%, 23.97% and 66.94%, respectively. The reliability analysis showed that the internal consistency coefficient (Cronbach’s α ) was 0.781，and the adjusted Cronbach’s α was 0.790, indicating the high reliability of the scale. The KMO value was 0.798, and the Bartlett’s spherical test value was 440.866, P=0.000. One factor was extracted by exploratory factor analysis. The factor loadings of the items were all above 0.5. Therefore, the high convergent validity was good. Conclusion The modified MMAS has good reliability and validity and is applicable for the evaluation of medication compliance for superficial mycoses. In this study, the military students have a low level of medication adherence for superficial mycoses. Effective measures should be taken to help students strengthen their daily medication management and improve compliance.

Objective    To explore the factors that affect the drainage time of da Vinci robot lung cancer surgery, to analyze the coping strategies, and to provide a basis for shortening the drainage time of patients after surgery and speeding up the patients' recovery. Methods    The clinical data of 131 patients who underwent da Vinci robot lung cancer surgery at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from January 2019 to October 2019 were retrospectively analyzed. Among them, 68 were males and 63 were females, with an average age of 59.84±9.66 years. According to the postoperative thoracic drainage time, the patients were divided into two groups including a group A (drainage time≤ 5 days) and a group B (drainage time >5 days). Univariate analysis and logistic multivariate regression analysis were used to analyze the factors that may affect postoperative drainage time, and the correlation between different influencing factors and thoracic drainage time after da Vinci robot lung cancer surgery. Results    Logistic multivariate analysis showed that age≥60 years (P=0.014), diabetes mellitus (P=0.035), operation time≥130 min (P=0.018), number of lymph node dissections≥15 (P=0.002), and preoperative albumin<38.45 g/L (P=0.010) were independent factors affecting the drainage time of da Vinci robot lung cancer surgery. Conclusion    For elderly patients with diabetes mellitus during the perioperative period, blood glucose should be actively controlled, reasonable surgical strategies should be formulated to ensure the safety and effectiveness of the operation, while reducing intraoperative damage and shortening the operation time. After the operation, patients should be guided to strengthen active coughing, expectoration and lung expansion. Thereby it can shorten drainage time and speed up the recovery of patients after operation.

Objective:To compare the short-term outcomes of segmentectomy for stage ⅠA non-small cell lung cancer by two surgical methods.Methods:A retrospective analysis was performed on 101 patients with stage ⅠA non-small cell lung cancer and undergoing segmentectomy admitted to the Department of Thoracic Surgery of The General Hospital of the Northern Theater Command from July 2016 to July 2020, including 50 patients who underwent Da Vinci robotic segmentectomy and 51 patients who underwent video-assisted thoracoscopic segmentectomy during the same period. By collecting the clinical data of the patients, the operation time, intraoperative blood loss, lymph node dissection stations, lymph node dissection number, drainage volume on the first day after the operation, total drainage volume on the third day after the operation, postoperative chest catheter insertion time, postoperative hospitalization days, and postoperative complication rate were compared and analyzed.Results:Patients in both groups successfully completed pulmonary segmental resection, and there were no cases of conversion to thoracotomy and perioperative death.Compared and analyzed the postoperative clinical results of the two groups, the intraoperative blood loss [(34.40±12.96) ml vs.(85.10±26.41)ml, P=0.000], the number of lymph node dissection stations(4.72±1.20 vs. 3.60±1.40, P=0.000) and the number of lymph node dissection(15.14±5.91 vs. 10.76±5.26, P=0.000) showed statistically significant differences, and RATS group was superior to VATS group.There were no statistically significant differences in operation time[(153.90±21.88) min vs.(155.39±25.04) min, P=0.751], drainage volume on the first day after surgery[(217.80±76.94) ml vs.(210.98±86.98) ml, P=0.678], total drainage volume three days after surgery[(612.60±169.93) ml vs.(595.10±203.90) ml, P=0.641], duration of chest drainage tube after operation[(5.36±2.33) days vs.(5.18±2.54) days, P=0.706], postoperative hospitalization days[(7.50±2.35) days vs.(7.47±2.93) days, P=0.956]and postoperative complication incidence. Conclusion:Da Vinci robot segmentectomy is a safe and effective surgical method, with less bleeding and more lymph node dissection stations and number than video-assisted thoracoscopic segmentectomy for stage ⅠA non-small cell lung cancer.

Clostridioides difficile is a key pathogen of antibiotic related diarrhea and hospital associated infection, causing several outbreaks in Europe and North Americans and resulting in severe disease burden. However, the standardized diagnostic principle and detection specifications in C. difficile infection (CDI) survey are limited in China, and the infection rate and disease burden of CDI in China are unclear. Therefore, National Institute for Communicable Disease Control and Prevention,National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, together with another 11 institutions, draft the group standard entitled "Diagnosis of Clostridium difficile infection (T/CPMA 008-2020)" of Chinese Preventive Medicine Association. Based on the principle of "legality, scientificity, advancement, and feasibility", this standard clarifies risk factors, diagnosis principles, diagnoses and differential diagnoses in order to improve the accuracy of CDI diagnosis in clinical practice, guide the surveillance for CDI, and understand the infection rate and disease burden of CDI in China .