With the rapid and widespread popularity of minimally invasive surgery, lapa-roscopic technology has become an indispensable core skill for contemporary surgeons. Based on the innovation of artificial intelligence and medical engineering integration technology, simulative virtual surgical medicine has also been rapidly developed and applied, providing a novel and effective tool for laparoscopic training. The authors′ team has systematically integrated the laparoscopic simulative virtual technology and led in conducting the empirical research on the application of laparoscopic simulative virtual technology in the practical skills examination of specialist physicians. They also developed laparoscopic training theory and operational practice courses. Besides, they normalized the training and assessment of simulated virtual systems. Notably, they formulated Chinese laparoscopic training and assessment standards, and constructed a phased and progressive training system for laparoscopic surgeons. The authors review relevant literature and discuss the exploration and practice of laparoscopic simulation virtual system in surgical residents training, in order to promote the standardization, normalization and homogenization of laparoscopic training in China.

Objective To investigate the expression of angiopoietin 1 and 2(Ang1,Ang2)in diffuse large B-cell lymphoma(DLBCL)and its survival prognosis analysis.Methods Peripheral blood was collected from 32 patients with initially diagnosed DLBCL and 30 healthy volunteers(the health control group),and the serum Ang1 and Ang2 levels were detected by ELISA.The biopsy tissues from DLBCL patients and the resec-ted normal lymph node biopsy tissues in neck surgery of 25 patients with non-tumor lesions(the control group)were taken as the specimens.The immunohistochemistry was used to detect the expression of CD34 in lymphoid tissues and the microvessel density was calculated;the statistical analyses were carried out by combi-ning with the clinical characteristics of the DLBCL patients and the follow-up data.Results The serum Ang1 level in initially diagnosed DLBCL was higher than that in the healthy control group[(36.22±9.12)ng/mL vs.(30.92±13.37)ng/mL],and the serum Ang2 level in initially diagnosed DLBCL was higher than that in the healthy control group[(28.42±10.78)ng/mL vs.(23.81±3.68))ng/mL],and the differences were sta-tistically significant(P＜0.05).CD34 was highly expressed in the lymphoma tissues of the patients with DL-BCL,whereas CD34 in normal lymph node tissues was weakly expressed;the microvessel density count in the DLBCL group was increased compared with the normal lymph node group(25.5±4.4 vs.13.2±3.0,P＜0.05).The Ang1 expression level had no significant correlation with the gender,age,IPI score,clinical stage and COO subtype.The Ang2 expression was correlated with the clinical stage,Ang2 was lowly expressed in the patients with stage Ⅰ-Ⅱ DLBCL,while which was highly expressed in the patients with stage Ⅲ-Ⅳ(P＜0.05);Ang2 had no significant correlation with the gender,age,IPI score and COO subtype.The OS time had no significant difference between the patients with Ang1 low expression and the patients with Ang1 high expression(25.86 months vs.23.11 months,P=0.722);the OS time in the patients with Ang2 low ex-pression was significantly higher than in the patients with high Ang2 expression(32.24 months vs.17.66 months,P=0.002).In the univariate analysis,Ann Arbor stage,IPI score and Ang2 all were the prognostic factors affecting the patients'OS,while gender,age and Ang1 had no significant correlation with the patients'OS.In Cox multifactorial analysis,the Ann Arbor stage,IPI score and Ang2 all were the independent prog-nostic factors affecting the patients'OS.prognostic factors.Conclusion Ang1 and Ang2 are highly expressed in DLBCL patients and promote lymphoma angiogenesis;Ang2 affects the survival prognosis of DLBCL patients.

Due to the unique nature of its anatomical location, the adenocarcinoma of esophagogastric junction (AEG) has been a subject of controversy and disagreement including its definition, staging, and treatment strategies. Chinse expert Consensus on Surgical Treatment of Adenocarcinoma of Esophagogastric Junction in China (2018 Edition) had been released in September 2018 and had played a pioneering role in unifying thoracic and general surgeons in China on surgical treatment strategies for AEG. Over the past five years, the emergence of several clinical research results on AEG has provided new clinical evidence for the selection of key surgical treatment strategies. Therefore, to further standardize the surgical treatment of AEG in China, Chinese Expert Consensus on Surgical Treatment of Adenocarcinoma of Esophagogastric Junction in China (2024 Edition) was released in 2024 by Chinese expert panel including 25 gastrointestinal surgeons and 24 thoracic surgeons. Based on the highest-level clinical research evidence in recent 5 years, this consensus ultimately formulates 29 recommendations on hotspots and key points on surgical treatment of AEG and summary 5 issues that are still awaiting further exploration. This review will provide a summary and detailed interpretation of the recommendations outlined in this consensus.

Objective:To analyze the safety of paclitaxel-based, hyperthermic, intraperitoneal perfusion chemotherapy (HIPEC) after radical resection of locally advanced gastric cancer.Methods:This was a retrospective cohort study of clinicopathological data of 467 patients with locally advanced gastric adenocarcinoma who had been admitted to the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University between July 2019 and April 2021. Among these patients, 151 had undergone radical resection combined with post-operative paclitaxel-based HIPEC (surgery+HIPEC group) and 316 radical resection alone (surgery group). The adverse perioperative events in study patients were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0) published by the U.S. Department of Health and Human Services. Subgroup analysis was performed on patients in the surgery+HIPEC group according to the number of times HIPEC was administered and the incidence of adverse events was compared between subgroups using the χ 2 test. Independent risk factors for paclitaxel-based HIPEC-associated adverse events were identified by applying a logistic model. Results:In the surgery+HIPEC group, there were 113 (74.8%) male and 38 (25.2%) female patients of median age 64 (55, 68) years, 18 (11.9%), 79 (52.3%), and 54 (35.8%) of whom had undergone one, two, and three paclitaxel-based HIPEC treatments, respectively, after surgery. The median maximum tumor diameter was 5.0 (3.6, 6.5) cm. In the surgery group, there were 244 (77.2%) male and 72 (22.8%) female patients of median age 63 (54, 68) and the median maximum tumor diameter was 4.0 (3.0, 5.5) cm. In the surgery+HIPEC group, 112 patients (74.2%) had 198 Grade 2 or higher adverse perioperative events, postoperative hypoalbuminemia being the commonest (85 cases, 56.3%), followed by postoperative anemia (50 cases, 33.1%). Compared with the surgery group, the incidences of postoperative hypoalbuminemia (56.3% [85/151] vs. 37.7% [119/316], χ 2=14.420, P<0.001), anemia (33.1% [50/151] vs. 22.5% [71/316], χ 2=6.030, P=0.014), abdominal pain [7.3% [11/151] vs. 1.6% [5/316], χ 2=10.042, P=0.002) and abdominal distension (5.3% [8/151] vs. 1.3% [4/316], χ 2=5.123, P=0.024) were all significantly higher in the surgery+HIPEC group. Analysis of the three HIPEC subgroups revealed significant differences in the incidences of postoperative hypoalbuminemia (13/18 vs. 67.1% [53/79] vs. 35.2% [19/54], χ 2=12.955, P<0.001) and pulmonary infection (6/18 vs. 6.3% [5/79] vs. 1.9% [1/54], χ 2=13.232, P<0.001) between them. Univariate analysis identified body mass index, Borrmann's type and number of HIPEC treatments as associated with perioperative adverse events in the surgery+HIPEC group ( P<0.05). However, according to multifactorial logistic analysis, the above factors were not independent risk factors for perioperative adverse events in the surgery+HIPEC group ( P>0.05). Conclusions:Paclitaxel-based HIPEC after radical resection significantly increases the risk of postoperative hypoalbuminemia, anemia, abdominal pain, and abdominal distension in patients who have undergone excision of locally advanced gastric cancer. However, increasing the frequency of HIPEC treatments did not significantly increase the risk of paclitaxel-based HIPEC-related adverse events. Moreover, univariate and multivariate analysis did not identify any independent risk factors for paclitaxel HIPEC-related adverse events.

Due to the unique nature of its anatomical location, the adenocarcinoma of esophagogastric junction (AEG) has been a subject of controversy and disagreement including its definition, staging, and treatment strategies. Chinse expert Consensus on Surgical Treatment of Adenocarcinoma of Esophagogastric Junction in China (2018 Edition) had been released in September 2018 and had played a pioneering role in unifying thoracic and general surgeons in China on surgical treatment strategies for AEG. Over the past five years, the emergence of several clinical research results on AEG has provided new clinical evidence for the selection of key surgical treatment strategies. Therefore, to further standardize the surgical treatment of AEG in China, Chinese Expert Consensus on Surgical Treatment of Adenocarcinoma of Esophagogastric Junction in China (2024 Edition) was released in 2024 by Chinese expert panel including 25 gastrointestinal surgeons and 24 thoracic surgeons. Based on the highest-level clinical research evidence in recent 5 years, this consensus ultimately formulates 29 recommendations on hotspots and key points on surgical treatment of AEG and summary 5 issues that are still awaiting further exploration. This review will provide a summary and detailed interpretation of the recommendations outlined in this consensus.

Objective:To analyze the safety of paclitaxel-based, hyperthermic, intraperitoneal perfusion chemotherapy (HIPEC) after radical resection of locally advanced gastric cancer.Methods:This was a retrospective cohort study of clinicopathological data of 467 patients with locally advanced gastric adenocarcinoma who had been admitted to the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University between July 2019 and April 2021. Among these patients, 151 had undergone radical resection combined with post-operative paclitaxel-based HIPEC (surgery+HIPEC group) and 316 radical resection alone (surgery group). The adverse perioperative events in study patients were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE 5.0) published by the U.S. Department of Health and Human Services. Subgroup analysis was performed on patients in the surgery+HIPEC group according to the number of times HIPEC was administered and the incidence of adverse events was compared between subgroups using the χ 2 test. Independent risk factors for paclitaxel-based HIPEC-associated adverse events were identified by applying a logistic model. Results:In the surgery+HIPEC group, there were 113 (74.8%) male and 38 (25.2%) female patients of median age 64 (55, 68) years, 18 (11.9%), 79 (52.3%), and 54 (35.8%) of whom had undergone one, two, and three paclitaxel-based HIPEC treatments, respectively, after surgery. The median maximum tumor diameter was 5.0 (3.6, 6.5) cm. In the surgery group, there were 244 (77.2%) male and 72 (22.8%) female patients of median age 63 (54, 68) and the median maximum tumor diameter was 4.0 (3.0, 5.5) cm. In the surgery+HIPEC group, 112 patients (74.2%) had 198 Grade 2 or higher adverse perioperative events, postoperative hypoalbuminemia being the commonest (85 cases, 56.3%), followed by postoperative anemia (50 cases, 33.1%). Compared with the surgery group, the incidences of postoperative hypoalbuminemia (56.3% [85/151] vs. 37.7% [119/316], χ 2=14.420, P<0.001), anemia (33.1% [50/151] vs. 22.5% [71/316], χ 2=6.030, P=0.014), abdominal pain [7.3% [11/151] vs. 1.6% [5/316], χ 2=10.042, P=0.002) and abdominal distension (5.3% [8/151] vs. 1.3% [4/316], χ 2=5.123, P=0.024) were all significantly higher in the surgery+HIPEC group. Analysis of the three HIPEC subgroups revealed significant differences in the incidences of postoperative hypoalbuminemia (13/18 vs. 67.1% [53/79] vs. 35.2% [19/54], χ 2=12.955, P<0.001) and pulmonary infection (6/18 vs. 6.3% [5/79] vs. 1.9% [1/54], χ 2=13.232, P<0.001) between them. Univariate analysis identified body mass index, Borrmann's type and number of HIPEC treatments as associated with perioperative adverse events in the surgery+HIPEC group ( P<0.05). However, according to multifactorial logistic analysis, the above factors were not independent risk factors for perioperative adverse events in the surgery+HIPEC group ( P>0.05). Conclusions:Paclitaxel-based HIPEC after radical resection significantly increases the risk of postoperative hypoalbuminemia, anemia, abdominal pain, and abdominal distension in patients who have undergone excision of locally advanced gastric cancer. However, increasing the frequency of HIPEC treatments did not significantly increase the risk of paclitaxel-based HIPEC-related adverse events. Moreover, univariate and multivariate analysis did not identify any independent risk factors for paclitaxel HIPEC-related adverse events.

TCM dispensing is the most basic clinical pharmaceutical work of TCM.In recent years,based on the 9 key technologies of TCM dispensing,the TCM dispensing industry has ushered in great development,and innovative TCM dispensing information system and intelligent dispensing equipment have appeared.This article sorted out the current situation of TCM dispensing industry and looked forward to its future development route.The results showed that the introduction of new technology and new equipment in the key technical links of procurement acceptance,dispensing review,TCM decocting,medication guidance and so on have improved the quality of dispensing service and ensured the quality and safety of medication.In the development of modern TCM dispensing industry,it is necessary to improve the quality control standard system,service standard system and core equipment standard system in the standardization of dispensing technology;in terms of talent cultivation in the field of dispensing,it is necessary to focus on restructuring and building new educational models to cultivate new medical talents that intersect medical and engineering fields;in terms of informatization and intelligence,it is necessary to develop intelligent equipment that is more in line with the characteristics of TCM,and further promote and improve the"shared TCM pharmacy"model.Through improving the content of TCM clinical pharmaceutical care,developing new technology and equipment of TCM dispensing,and improving the level of dispensing service and education,it is expected to gradually realize the standardization,informatization and intelligent development of modern TCM dispensing industry.

Objective To retrospectively analyse the use of TCM injections in Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University from 2019 to 2023;To evaluate the reasonableness of its clinical use of medication;To provide theoretical guidance for clinical work in the new situation.Methods Relevant data on the use of TCM injections in a hospital from 2019 to 2023 were collected,and the research method of retrospective analysis was used to analyse their use and medication law.Results From 2019 to 2023,the overall amount of use of TCM injections and the ratio of the amount of use of Western patent medicines showed a downward trend year by year;the amount of anti-neoplastic drugs TCM injections ranked in the first place although it decreased year by year,and the amount of use of enucleating agents and oncological auxiliary drugs TCM injections showed a downward trend;the changes in the consumption of TCM injections,the defined daily doses,and the defined daily cost fluctuated greatly,which was relevant to the medical insurance policy and the inclusion of the nationally negotiated medicines;both the infection of COVID-19 and medical policy played a great influence on the application of TCM injections.Conclusion The use of TCM injections is subject to changes in policy and the influence of social environment,and the supervision of the use of TCM injections should be strengthened to ensure the rational use of medication and medication safety for patients.

Objective To analyze the use of Chinese patent medicines containing toxic TCM decoction pieces in Beijing Hospital of Traditional Chinese Medicine of Capital Medical University(hereinafter referred to as"our hospital")from 2021 to 2023;To provide references for reasonable management of Chinese patent medicines containing toxic TCM decoction pieces in medical institutions.Methods The Chinese patent medicines containing toxic TCM decoction pieces from 2021 to 2023 were collected in our hospital.Statistics on the number of varieties,efficacy and sales amount of Chinese patent medicines containing toxic TCM decoction pieces were performed.Results From 2021 to 2023,there were 110 kinds of Chinese patent medicines containing toxic TCM decoction pieces and 10 kinds of Chinese patent medicines containing TCM decoction pieces with heavy toxicity,among which the ones of promoting blood circulation and removing blood stasis ranked first.The top 3 TCM decoction pieces with heavy toxicity were raw Aconiti Kusnezoffii Radix,raw Aconiti Radix,Strychni Semen;the top 5 TCM decoction pieces with toxicity were Cinnabaris,Realgar,processed Aconiti Kusnezoffii Radix,Aconiti Lateralis Radix Praeparata,Scorpio;the top 3 TCM decoction pieces with light toxicity were Armeniacae Semen Amarum,Hirudo,Eupolyphaga Steleophaga.The top 15 Chinese patent medicines containing toxic TCM decoction pieces in our hospital was relatively stable,especially the Guanjie Kebi Pills in the first place.Conclusion Based on the analysis of the use of Chinese patent medicines containing toxic TCM decoction pieces from 2021 to 2023,this article discuss measures to ensure the safe use of Chinese patent medicines containing toxic TCM decoction pieces,with certain feasibility and necessity.

BACKGROUND: The results of studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) reconstruction on the quality of life (QoL) are still inconsistent. The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer. METHODS: A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital, Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group ( N  = 70) and R-Y group ( N  = 70). The follow-up time points were 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after the operation. The final follow-up time was May 2019. The clinicopathological features, operative safety, postoperative recovery, long-term survival as well as QoL were compared, among which QoL score was the primary outcome. An intention-to-treat analysis was applied. RESULTS: The baseline characteristics were comparable between the two groups. There were no statistically significant differences in terms of postoperative morbidity and mortality rates, and postoperative recovery between the two groups. Less estimated blood loss and shorter surgical duration were found in the B-I group. There were no statistically significant differences in 5-year overall survival (79% [55/70] of the B-I group vs. 80% [56/70] of the R-Y group, P  = 0.966) and recurrence-free survival rates (79% [55/70] of the B-I group vs. 78% [55/70] of the R-Y group, P  = 0.979) between the two groups. The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences (postoperative 1 year: 85.4 ± 13.1 vs . 88.8 ± 16.1, P  = 0.033; postoperative 3 year: 87.3 ± 15.2 vs . 92.8 ± 11.3, P  = 0.028; postoperative 5 year: 90.9 ± 13.7 vs . 96.4 ± 5.6, P  = 0.010), and the reflux (postoperative 3 year: 8.8 ± 12.9 vs . 2.8 ± 5.3, P  = 0.001; postoperative 5 year: 5.1 ± 9.8 vs . 1.8 ± 4.7, P  = 0.033) and epigastric pain (postoperative 1 year: 11.8 ± 12.7 vs. 6.1 ± 8.8, P  = 0.008; postoperative 3 year: 9.4 ± 10.6 vs. 4.6 ± 7.9, P  = 0.006; postoperative 5 year: 6.0 ± 8.9 vs . 2.7 ± 4.6, P  = 0.022) were milder in the R-Y group than those of the B-I group at the postoperative 1, 3, and 5-year time points. CONCLUSIONS: Compared with B-I group, R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain, without changing survival outcomes. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR-TRC-10001434.
Humans ; Stomach Neoplasms/pathology* ; Anastomosis, Roux-en-Y/methods* ; Quality of Life ; Treatment Outcome ; Gastrectomy/methods* ; Postoperative Complications ; Gastroenterostomy/methods* ; Pain