Objective:To explore the efficacy of immune checkpoint inhibitors combined with adjuvant chemotherapy in patients with phase III gastric cancer and esophagogastric junction cancer.Methods:This study used a retrospective cohort study method based on real-world data. Clinical data of 403 patients with stage III gastric/esophagogastric junction cancer who underwent gastrectomy followed by adjuvant therapy in the Department of Gastric Surgery at Sun Yat-sen University Cancer Center from January 2020 to December 2023 were retrospectively collected. The study cohort comprised 147 (36.5%) patients with stage IIIA, 130 (32.3%) with stage IIIB, and 126 (31.3%) with stage IIIC gastric/esophagogastric junction cancer. Of them, 15 (3.7%) were HER-2 positive, 25 (6.2%) dMMR, and 22 (5.5%) patients Epstein-Barr virus encoding RNA (EBER) positive. Based on treatment plans, the patients were divided into immune checkpoint inhibitor combined with chemotherapy group (immune therapy group, n=110, 71 males and 39 females, median age 59 years old) and chemotherapy alone group (chemotherapy group, n=293, 186 males and 107 females, median age 60 years old). All patients in the immunotherapy group received immune checkpoint inhibitors targeting the programmed cell death protein-1 (PD-1) and its ligand (PD-L1). Of them, 85 received pembrolizumab, 10 received sintilimab, 8 received tislelizumab, 4 received camrelizumab, 2 received toripalimab, and 1 received pabocizumab. The adjuvant chemotherapy regimens used among the chemotherapy alone group includes SOX regimen (132 cases), XELOX (102 cases), S-1 monotherapy (44 cases), and other regimens (15 cases). The 3-year DFS rate of the two groups was compared, and subgroup analysis was conducted based on different ages, molecular phenotypes, pTNM staging, extranodal infiltration, and tumor length. Results:The median follow-up was 20.5 months (range 3.1~46.3), with a 3-year overall DFS rate of 61.4% for the entire 403 patients. The 3-year DFS rate for the immunotherapy group was 82.7%, higher than the chemotherapy alone group (58.8%), with a statistically significant difference ( P=0.021). Multivariate analysis showed that postoperative immunotherapy was a protective factor for DFS (HR=0.352, 95%CI: 0.180~0.685). Subgroup analysis showed that stage IIIC (HR=0.416, 95%CI: 0.184~0.940), aged ≥60 years (HR=0.336, 95%CI: 0.121~0.934) and extranodal invasion (HR=0.378, 95%CI: 0.170~0.839) were associated with benefit from the combined immune adjuvant chemotherapy, while no association was observed for MMR, HER-2 or EBER status. Conclusion:Stage III gastric/esophagogastric junction cancer patients may benefite from postoperative immune checkpoint inhibitor combined with adjuvant chemotherapy in real-world settings.

Objective:To explore the efficacy of immune checkpoint inhibitors combined with adjuvant chemotherapy in patients with phase III gastric cancer and esophagogastric junction cancer.Methods:This study used a retrospective cohort study method based on real-world data. Clinical data of 403 patients with stage III gastric/esophagogastric junction cancer who underwent gastrectomy followed by adjuvant therapy in the Department of Gastric Surgery at Sun Yat-sen University Cancer Center from January 2020 to December 2023 were retrospectively collected. The study cohort comprised 147 (36.5%) patients with stage IIIA, 130 (32.3%) with stage IIIB, and 126 (31.3%) with stage IIIC gastric/esophagogastric junction cancer. Of them, 15 (3.7%) were HER-2 positive, 25 (6.2%) dMMR, and 22 (5.5%) patients Epstein-Barr virus encoding RNA (EBER) positive. Based on treatment plans, the patients were divided into immune checkpoint inhibitor combined with chemotherapy group (immune therapy group, n=110, 71 males and 39 females, median age 59 years old) and chemotherapy alone group (chemotherapy group, n=293, 186 males and 107 females, median age 60 years old). All patients in the immunotherapy group received immune checkpoint inhibitors targeting the programmed cell death protein-1 (PD-1) and its ligand (PD-L1). Of them, 85 received pembrolizumab, 10 received sintilimab, 8 received tislelizumab, 4 received camrelizumab, 2 received toripalimab, and 1 received pabocizumab. The adjuvant chemotherapy regimens used among the chemotherapy alone group includes SOX regimen (132 cases), XELOX (102 cases), S-1 monotherapy (44 cases), and other regimens (15 cases). The 3-year DFS rate of the two groups was compared, and subgroup analysis was conducted based on different ages, molecular phenotypes, pTNM staging, extranodal infiltration, and tumor length. Results:The median follow-up was 20.5 months (range 3.1~46.3), with a 3-year overall DFS rate of 61.4% for the entire 403 patients. The 3-year DFS rate for the immunotherapy group was 82.7%, higher than the chemotherapy alone group (58.8%), with a statistically significant difference ( P=0.021). Multivariate analysis showed that postoperative immunotherapy was a protective factor for DFS (HR=0.352, 95%CI: 0.180~0.685). Subgroup analysis showed that stage IIIC (HR=0.416, 95%CI: 0.184~0.940), aged ≥60 years (HR=0.336, 95%CI: 0.121~0.934) and extranodal invasion (HR=0.378, 95%CI: 0.170~0.839) were associated with benefit from the combined immune adjuvant chemotherapy, while no association was observed for MMR, HER-2 or EBER status. Conclusion:Stage III gastric/esophagogastric junction cancer patients may benefite from postoperative immune checkpoint inhibitor combined with adjuvant chemotherapy in real-world settings.

Objective:To investigate and analyze the employment status of college graduates majoring in health service and management in China.Methods:From April 2023 to June 2024, a cross-sectional survey was conducted on undergraduate graduates majoring in health service and management from 34 universities in China using convenient sampling method. General information was collected (such as gender, household registration at graduation, only child status, average monthly family income, previous experience as a student cadre, average grade point, part-time job experience, entrepreneurial experience, whether a first batch graduate of the university and the major, self-assessment of professional competence level) alongside employment status. Statistical descriptive analysis was employed to analyze the graduates′ basic employment situation, job competence and professional skill demand, types of certificates valued by employers, factors influencing job selection, evaluation of work and profession, and perceptions of professional employment prospects. A total of 1 417 questionnaires were collected in this study, with 1 315 valid responses (92.8%). Chi-square tests were used to compare employment differences among various factors, and binary logistic regression was used to analyze factors influencing employment outcomes.Results:Among 564 employed graduates in the Health Services and Management field, 98 (17.4%) work in health management companies and 97 (17.2%) in hospitals. Regarding important job competencies, 413 (73.2%), 409 (72.5%), and 364 (64.5%) respectively emphasized the importance of information collection and statistical analysis, organizational coordination, and communication skills. Key professional skills highly valued by employers included health risk assessment 175 (66.3%), health measurement 160 (60.6%), and health education and promotion 152 (57.6%). Additionally, 281 (49.8%) highlighted the importance of Health Management Professional Qualification Certificates. Factors influencing job choices included salary and benefits 454 (80.5%) and personal interests and hobbies 279 (49.5%). While 397 (70.4%) of the graduates provided positive feedback on their profession, only 274 (48.6%) were optimistic about their future job prospects. Binary logistic regression analysis indicated significant correlations (all P<0.05) between employment outcomes and factors such as part-time work experience ( OR=1.31) and average grade point ( OR=0.61, 0.68). Conclusions:The employment rate of undergraduate graduates majoring in health service and management in China is low in the health service market, with a low degree of job specialization matching. Graduates are not optimistic about the future employment prospects in their field, possibly due to unclear positioning in talent cultivation in universities and an imperfect job market.

ObjectiveTo investigate the prevalence of overweight， obesity and fatty liver disease （FLD） in adult residents in a suburban area of Shanghai， and to explore the relationship between these conditions and eating out of home （EOH）. MethodsAdult residents from Zhongshan Street， Songjiang， Shanghai， were invited to report their frequency of EOH and undergo a physical examination using B-ultrasonography from May to September 2017. Binary logistic regression analyses were conducted to examine the relationship between EOH and conditions of overweight， obesity， and FLD. ResultsAmong the final sample size of 6 608 participants， the prevalence rates of overweight， obesity， and FLD were 41.65%， 14.71% and 38.29%， respectively. After adjusting for potential confounders， logistic analyses revealed that participants with an EOH frequency > once/week had a 1.44-fold higher prevalence of obesity （P=0.006）， a 1.35-fold higher prevalence of overweight/obesity （P=0.005）， and a 1.36-fold higher prevalence of FLD （P=0.008）. ConclusionThe prevalence of overweight， obesity， and FLD is relatively high in Songjiang， Shanghai. EOH may be a risk factor for these diseases， and residents are recommended to reduce the frequency of EOH.

Endodontic microsurgery is a vital treatment modality for teeth with persistent periradicular pathoses that have not responded to nonsurgical retreatment. The principle is to determine the reason for failure, completely eliminate the infection and promote periapical healing. Within recent years, endodontic microsurgery has evolved to become standardized and presents with a high success rate. However, its outcome is still influenced by many factors, including anatomy, periodontal condition, crown-to-root ratio, occlusion, the type of periradicular lesion, and prosthesis. Moreover, endodontists always concentrate on “the apex”, paying little attention to the general preoperative evaluation, accurate diagnosis, and comprehensive treatment plan. This article reviews the latest literature on these issues and the clinical experience of our research group and discusses the correlation between endodontic microsurgery and other oral disciplines, including periodontology, prosthodontics, oral implantology, oral and maxillofacial surgery and orthodontics. The oral interdisciplinary assessment should be made with comprehensive consideration of the root canal system, periradicular lesion, adjacent anatomical relationships, periodontal condition, occlusion, and esthetic rehabilitation. Based on these findings, the continuity of treatment will be optimized, and the best treatment plan will be proposed to provide clinical strategies for the diagnosis and treatment of complex periradicular diseases.

To access the efficacy of stents for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). The study is a prospective single-arm study which has been registered on Clinical Trials (NCT03916965). Clinical data and follow-up information of the SIDSMA patients who received stent implantation in the First Affiliated Hospital of Zhejiang University during April 1, 2019 and September 30, 2019 were collected. The patients were recommended to be followed up at 1, 3, 6 and 12 months. A total of 34 patients were enrolled. Their mean age was (54±8) years. Abdominal pain was the most common symptom. Patients received (2.1±0.6) stents on the average. Post-operation hospital stay was (2.7±1.6) days, and the patients were followed up for (2.3±1.9) months (CT angiography) and (5.5±1.7) months (clinical visit/phone call). There was no recurrence of abdominal pain. The CT angiography showed complete remodeling and incomplete remodeling took place in 23 and 9 patients (69.7% and 27.3%), respectively. Two patients (6.1%) had mild in-stent stenosis. No stent rupture or migration was reported. This study demonstrated a satisfactory short-term result of stents implantation for SIDSMA, which indicated the endovascular treatment could be the first-line therapy for SIDSMA.
Aneurysm, Dissecting ; Endovascular Procedures ; Humans ; Mesenteric Artery, Superior ; Middle Aged ; Prospective Studies ; Retrospective Studies ; Stents ; Treatment Outcome

Objective To explore the effect of reduced alpha - cardiac actin 1(ACTC1)gene expression on the rat embryonic cardiomyocytes H9C2 cell apoptosis and its mechanism. Methods The rat embryonic cardiomyocytes H9C2 cell was cultivated;the rat embryonic cardiomyocytes H9C2 cell was transfected with ACTC1 - small interfering RNA(siRNA),and at 24 h,48 h,72 h after transfection,the cells were collected for extraction and purification of RNA, the real - time quantitative PCR(qPCR)method was used to detect the expression level of ACTC1 gene;and the termi-nal deoxynucleotidyl transferase - mediated dUTP - biotin nick end labeling assay(TUNEL)method was used to ex-plore the effect of reduced ACTC1 gene expression on the rat embryonic cardiomyocytes H9C2 cell apoptosis. Western blot was used to detect the expression of Cyto C,cysteine - containing aspartate - specific proteases(Caspase)- 3, Caspase - 8,Caspase - 9,Bcl - 2 and Bax. Results The expression of ACTC1 mRNA detected by qPCR decreased compared with that of the scramble siRNA group in 24 h,48 h,72 h(0. 80 vs. 1. 00,0. 20 vs. 1. 00,0. 25 vs. 1. 00),and in the ACTC1 - siRNA group decreased significantly at 48 h,72 h,and the difference was statistically significant(t =4. 245,P < 0. 05);TUNEL positive cells rate significantly increased in the ACTC1 - siRNA group(80％)compared with that in the scramble siRNA group(20％),and the difference was statistically significant(P < 0. 05);Western blot also confirmed that the expression of Caspase - 3,Caspase - 9,Cyto C and Bax/ Bcl - 2 were accordingly increased (0. 91 ± 0. 12 vs. 0. 59 ± 0. 01,0. 48 ± 0. 09 vs. 0. 24 ± 0. 03,0. 92 ± 0. 03 vs. 0. 45 ± 0. 01,2. 25 ± 0. 26 vs. 1. 16 ± 0. 12),and the differences were statistically significant(t = 2. 821,7. 336,2. 420,0. 798,all P < 0. 05);but the expre-ssion of Caspase - 8 had no obvious change,and the difference was not statistically significant (P > 0. 05 ). Conclusions Reduced ACTC1 gene expression can induce the rat embryonic cardiomyocytes H9C2 cell apoptosis perhaps mainly through endogenous mitochondrial signal transduction pathways.

Objective To evaluate percutaneous AngioJet thrombectomy in the treatment of iliofemoral deep venous thrombosis (DVT).Methods A total of 36 patients with 38 legs of lower extremity DVT treated by AngioJet mechanical thrombectomy from Feb 2016 to Dec 2016 were analyzed retrospectively.The effect of lower limb venous recanalization was evaluated by observing the intraoperativeangiography and the results of postoperative follow-up including complaints,signs,and lower extremity venous ultrasound or CT and Villalta scores.Results Thrombosis was completely dissolved by AngioJet thrombectomy device in 32 out of 38 legs (84.2％) at first stage.Slight bleeding occurred in 4 cases,1 patient could not tolerate the operation.23 patients were followed-up for 6 months,venous patency was present in 21 of 23 patients (91.3％).11 patients complete the one-year follow-up,9 patients (81.8％) were in the 0-4 Villalta group.Conclusions AngioJet can effectively and safely remove thrombus in the lower extremity deep venous system.It is especially advantageous for patients who have contraindications for thrombolysis with a satisfactory short term venous patency.

SUMMARY An involved internal iliac artery is usually embolized when performing endovascular aneu -rysm repair for aortoiliac or isolated iliac artery aneurysm .This can lead to complications such as buttock claudication ,colon ischaemia and erectile dysfunction .Iliac branch device ( IBD ) is an endograft de-signed specifically for iliac bifurcation to preserve internal iliac flow .It was performed with high technical success rates and encouraging mid-term patency .Here we report a case of right iliac aneurysm developed 3 years after endovascular aneurysm repair for an aortoiliac aneurysm , with the patient ’ s left internal ar-tery been sacrificed then .Using a handmade IBD , we excluded the aneurysm without occlusion of the ip-silateral internal iliac artery or any type of endoleak .Both the design and deployment of this IBD are dis-tinctive that we would like to share our experience with all the colleagues .

Objective To explore the possible mechanisms of the protective effect of leflunomide on kidneys by observing the effects of leflunomide on rat kidney tissue of focal segmental glomerulosclerosis (FSGS) expression level of transforming growth factor (TGF)-β1.Methods Twenty-four SD rats were randomly divided into 3 groups:normal control group (n =8),FSGS model group (n =8) and leflunomide treatment group (n =8).Unilateral nephrectomy 1 week after repeated injection of doxorubicin established FSGS model.Since 2 weeks after surgery,the treatment group had been given the leflunomide suspension 5 mg/(kg · d) orally,while normal control group and model group had been given the same amount of solvent orally.In the 8th week of the experiment,the rats were sacrificed and the specimens were collected,so serum creatinine,blood urea nitrogen,total cholesterol,albumin and 24 hours urinary protein were recorded; renal tissue was taken for pathological examination and calculation of glomerular sclerosis index (GSI) was made;immunohistochemical detection of TGF-β1 expression in the kidney was performed;The expression of TGF-β1 was examined by Western blot.Results Compared with normal control group,FSGS model group and leflunomide treatment group rats' 24 hours urinary protein excretion,serum creatinine,blood urea nitrogen,and cholesterol significantly increased while serum albumin significantly reduced severe renal pathological changes and TGF-β1 protein expression was significantly increased,and the differences were statistically significant (all P ＜ 0.05) ; Compared with the FSGS model group,in the 8th weekend of the experiments,the treated rats' 24 hours urinary protein excretion,relevant serum biochemical indicators of renal pathological changes had different degrees of improvement in renal tissue and TGF-β1 protein expression was decreased,so the differences above were statistically significant(all P ＜ 0.05).Conclusions Leflunomide may reduce the FSGS kidney tissue fibrosis by inhibiting the expression of TGF-β1,and thus protect the kidneys.