Objective:To investigate the overall recurrence rate and the pattern of treatment failure in thoracic esophageal cancer (TEC) patients after minimally invasive esophagectomy (MIE), and to evaluate the significance of adjuvant therapy after MIE.Methods:Clinical data of TEC patients who underwent MIE with or without neoadjuvant chemotherapy in the Fourth Hospital of Hebei Medical University between 2016 and 2018 were retrospectively analyzed. The pathology-based lymph node metastasis (LNM) rate, overall recurrence rate, and pattern of treatment failure following MIE were analyzed by SPSS 26.0 statistical software. Cox regression model was used to identify the high-risk factors for recurrent disease. Propensity score matching was performed to compare the survival of patients between the postoperative radiotherapy group and non-radiotherapy group.Results:A total of 443 eligible patients were enrolled in this study, and the pathology-based LNM rate in all groups was 42.0%. The overall recurrence rate was 34.8%. Regional lymphatic metastasis was the most frequent pattern of recurrence (24.2%), followed by distant metastasis (19.4%). Multivariate Cox regression analysis identified pT 3-4 stage and pN + stage as the independent risk factors for recurrence. At the same time, the total number of lymph nodes dissected ≥12 and the number of lymph nodes dissected ≥7 in the neck clavicle and upper mediastinum could reduce the risk of tumor recurrence. The 1-, 3-, and 5-year disease-free survival (DFS) rates in the postoperative radiotherapy group and non-radiotherapy group were 83.5%, 66.8%, 60.7%, and 79.2%, 61.6%, 57.2%, respectively ( χ2=0.13, P=0.715). The 1-, 3-, and 5-year overall survival (OS) rates in two groups were 92.0%, 72.0%, 67.5% and 84.0%, 68.0%, 55.4% , respectively ( χ2=0.43, P=0.513). Conclusions:Regional lymphatic and distant metastases are the main patterns of recurrence for TEC patients after MIE with or without neoadjuvant chemotherapy. pT 3-4 stage, pN + stage, insufficient total number of lymph node dissection and insufficient number of lymph nodes in neck supraclavicular and upper mediastinal dissection are high-risk factors for postoperative recurrence. The survival rate in the postoperative radiotherapy group tends to be higher than that in the non-radiotherapy group. Adjuvant therapy, including postoperative radiotherapy, may remain necessary.

Objective To analyze and summarize the epidemiological characteristics of gastric Helicobacter pylori in pa-tients experiencing gastric discomfort in Yuexiu Dongshan Community,Guangzhou.Methods A total of 312 patients who visited Yuexiu District Dongshan Community Health Service Center for stomach upset testing between April 2023 and July 2023 were en-rolled in the study.The distribution characteristics of positive Helicobacter pylori were analyzed among the patients of different age and gender.Results Out of the 312 cases in the population,93 cases tested positive and 219 tested negative,with a positive de-tection rate of 29.81%.Specifically,28 cases tested positive,and 74 cases tested negative in the male population,with a positive detection rate of 27.45%.In the female population,65 cases tested positive,and 145 cases tested negative,with a positive detec-tion rate of 30.95%.The difference in positive rates by gender was not statistically significant(X2 =0.402,P=0.526).Among the male patients infected with Helicobacter,the mean value of delta over baseline of the C13 urea breath test(DOB)was(17.31±11.84).The DOB value was insignificantly higher in the males than in the females(t =1.430,P=0.156).There was no signifi-cant increasing or decreasing trend in the distribution of positive rates by age.The composition ratio of positive patients was predom-inant in the group aged 40 and above,accounting for 79.57%of the total number of positive cases.Among the individuals aged less than 60 infected with Helicobacter pylori,the mean duration of the breath test was(14.95±11.87),while among those aged over 61,the mean duration of the breath test was(24.66±22.71).The disparity between the two groups was statistically significant(t =2.643,P=0.009 7).Conclusion Gastric Helicobacter pylori can be detected in individuals of all genders and ages,and it is a primary cause of gastric discomfort.Community-based C13 breath tests can detect the presence of infections of helicobacter py-lori at an early stage.Antibiotics can be administered to treat the infections,thereby reducing the incidence of gastric tumors.

Objective:To explore the impact of uncertain resection on postoperative survival in non-small cell lung cancer.Methods:This is a retrospective cohort study. A retrospective analysis was conducted on the data of 477 patients with non-small cell lung cancer who underwent lobectomy in the Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University from December 2012 to December 2013. There were 302 males and 175 females, aged (59±8) years (range: 27 to 79 years). According to the surgical resection criteria issued by the International Association for the Study of Lung Cancer, the patients were divided into the intact resection group (R0 group, 286 cases) and the uncertain resection group (R (un) group, 191 cases). Clinical data between the two groups were compared using χ2 test, and propensity score matching (PSM) was performed on patients using the R language, with matching variables including gender, age, smoking history, adjuvant therapy, TNM stage, pathological type, and tumor site. The nearest-neighbor method was used for 1∶3 matching and the caliper value was 0.02. The survival curve was plotted using the Kaplan-Meier method and compared using the Log-rank test. The Cox proportional hazards regression model was used to identify risk factors in overall survival (OS). Subgroup analysis was based on TNM staging and mediastinal lymph node metastasis status. Results:In the R (un) group, 68 patients had positive lymph in the highest group and 129 patients did not undergo complete dissection of the mediastinal lymph nodes. The baseline data for the R0 group and the R (un) group were corrected using PSM, and a total of 369 patients were successfully matched, including 227 cases in the R0 group and 142 cases in the R (un) group. After PSM, the 5-year survival rates of the R0 group and the R (un) group were 64.3% and 52.1%, respectively ( P=0.021). The 5-year survival rates of stage Ⅰ, Ⅱ, and Ⅲ patients were 85.2%, 65.9%, and 34.8%, respectively ( P<0.01). TNM stage ( χ2=46.913, P<0.01), pathological classification of adenosquamous cell carcinoma ( HR=5.970, 95% CI: 3.117 to 11.431, P<0.01) and R (un) resection ( HR=1.512, 95% CI: 1.065 to 2.147, P=0.021) were prognostic factors for postoperative survival. Subgroup analysis showed that in stage Ⅲ patients, 5-year survival rates of the R0 group and the R (un) group after resection were 45.8% and 9.5%, respectively ( P=0.002). Among patients with mediastinal lymph node metastasis, 5-year survival rates of the R0 group and the R (un) group were 50.6% and 7.1%, respectively ( P<0.01). Conclusions:TNM staging, pathological type, and R (un) resection are prognostic factors for overall postoperative survival in non-small cell lung cancer. In stage Ⅰ and Ⅱ patients, R (un) is not a prognostic factor for postoperative survival of non-small cell lung cancer. In patients with stage Ⅲ and mediastinal lymph node metastasis, R (un) is a prognostic factor for non-small cell lung cancer after surgery.

Objective:To explore the impact of uncertain resection on postoperative survival in non-small cell lung cancer.Methods:This is a retrospective cohort study. A retrospective analysis was conducted on the data of 477 patients with non-small cell lung cancer who underwent lobectomy in the Department of Thoracic Surgery, the Fourth Hospital of Hebei Medical University from December 2012 to December 2013. There were 302 males and 175 females, aged (59±8) years (range: 27 to 79 years). According to the surgical resection criteria issued by the International Association for the Study of Lung Cancer, the patients were divided into the intact resection group (R0 group, 286 cases) and the uncertain resection group (R (un) group, 191 cases). Clinical data between the two groups were compared using χ2 test, and propensity score matching (PSM) was performed on patients using the R language, with matching variables including gender, age, smoking history, adjuvant therapy, TNM stage, pathological type, and tumor site. The nearest-neighbor method was used for 1∶3 matching and the caliper value was 0.02. The survival curve was plotted using the Kaplan-Meier method and compared using the Log-rank test. The Cox proportional hazards regression model was used to identify risk factors in overall survival (OS). Subgroup analysis was based on TNM staging and mediastinal lymph node metastasis status. Results:In the R (un) group, 68 patients had positive lymph in the highest group and 129 patients did not undergo complete dissection of the mediastinal lymph nodes. The baseline data for the R0 group and the R (un) group were corrected using PSM, and a total of 369 patients were successfully matched, including 227 cases in the R0 group and 142 cases in the R (un) group. After PSM, the 5-year survival rates of the R0 group and the R (un) group were 64.3% and 52.1%, respectively ( P=0.021). The 5-year survival rates of stage Ⅰ, Ⅱ, and Ⅲ patients were 85.2%, 65.9%, and 34.8%, respectively ( P<0.01). TNM stage ( χ2=46.913, P<0.01), pathological classification of adenosquamous cell carcinoma ( HR=5.970, 95% CI: 3.117 to 11.431, P<0.01) and R (un) resection ( HR=1.512, 95% CI: 1.065 to 2.147, P=0.021) were prognostic factors for postoperative survival. Subgroup analysis showed that in stage Ⅲ patients, 5-year survival rates of the R0 group and the R (un) group after resection were 45.8% and 9.5%, respectively ( P=0.002). Among patients with mediastinal lymph node metastasis, 5-year survival rates of the R0 group and the R (un) group were 50.6% and 7.1%, respectively ( P<0.01). Conclusions:TNM staging, pathological type, and R (un) resection are prognostic factors for overall postoperative survival in non-small cell lung cancer. In stage Ⅰ and Ⅱ patients, R (un) is not a prognostic factor for postoperative survival of non-small cell lung cancer. In patients with stage Ⅲ and mediastinal lymph node metastasis, R (un) is a prognostic factor for non-small cell lung cancer after surgery.

Objective: To explore the microbial correlation between oral tongue coating (TC) and gastric mucosa (GM) in patients with gastric intestinal metaplasia (GIM). Methods: The present study recruited 1360 volunteers for upper gastrointestinal cancer screening. The microbiota in TC and GM were profiled by long-read sequencing of full-length 16S rRNA gene. The microbial diversity, community structure, and linear discriminant analysis effect size (LEfSe) were analyzed by the software Visual Genomics. SparCC correlation analysis was used to construct the commensal network and the graphical display was conducted by R software. Results: The population included 44 patients with precancerous GIM, and 28 matched controls with negative rapid urease test (RUT) and non-symptomatic chronic superficial gastritis (CSG). No significant difference in diversity was observed between GIM patients and controls in TC or GM microbiota (P > 0.05). Patients had a higher percentage of 41 – 60 co-occurring operational taxonomic units (OTUs) between TC and GM than controls (34.1% vs. 25.0%) (P < 0.05). The LEfSe showed that TC Prevotella melaninogenica and three gastric Helicobacter species (i.e., Helicobacter pylori, Helicobacter pylori XZ274, and Helicobacter pylori 83) were enriched in patients with GIM. Furthermore, GIM patients with positive RUT had a lower percentage of co-occurring OTUs over 20 (P < 0.05), and lower abundances of gastric Veillonella, Pseudonocardia, and Mesorhizobium than those with negative RUT (P < 0.05). The commensal network between TC and GM was more complex in GIM patients than in controls. GIM patients with positive RUT demonstrated more bacterial correlations between TC and GM than those with negative RUT. Finally, the serum ratio of PG-I/II was negatively correlated with three gastric Helicobacter species (Helicobacter pylori, Helicobacter pylori XZ274, and Helicobacter pylori 83) in patients with negative RUT (P < 0.05), and negatively correlated with two TC species (Fusobacterium nucleatum subsp. nucleatum and Campylobacter showae) in patients with positive RUT (P < 0.05). Conclusion The development of GIM potentiated the commensal network between oral TC and GM, providing microbial evidence of the correlation between TC and the stomach.

Objective : To investigate the effects of dihydroartemisinin ( DHA) on cell growth , migration invasion and vasculogenic mimicry ability of non⁃small cell lung cancer ( NSCLC) . Methods : Different concentrations of DHA were added to NSCLC cell lines A549 and H3255 , and after 24 hours , the cell viability was detected by CCK8 method , and the migration and invasion ability of NSCLC cells was detected by Transwell experiment . qRT⁃PCR and Western blot detected E ⁃cadherin , N ⁃cadherin , and Vimentin mRNA and protein expression levels , respectively .Three⁃dimensional cell was cultured to observe the vascular⁃like morphological generation of cells . qRT⁃PCR and Western blot detected human vascular endothelial cadherin (VE⁃cadherin) mRNA and protein expression levels as marker of vasculogenic mimicry . Results : DHA inhibited cell growth of A549 and H3255 and showed time⁃dependent and concentration⁃dependent . DHA inhibits the invasion and metastasis ( all P < 0. 001) of A549 and H325 cells ; DHA upregulated the expression of E ⁃Cadherin at mRNA(all P < 0. 001) and protein(P < 0. 001;P < 0. 01) levels in A549 and H3255 cells , and downregulated the expression of N ⁃cadherin at mRNA (all P < 0. 01) and protein (all P < 0. 001) levels as well as the expression of Vimentin at mRNA (P < 0. 01;P < 0. 001) and protein (all P < 0. 001) levels . The results of three⁃dimensional cell culture showed that the 12⁃hour vasculogenic mimicry generation capacity of DHA⁃treated A549 cells and H3255 cells was reduced , and the expressions of VE⁃cadherin at mRNA (P < 0. 001;P < 0. 01) and protein (all P < 0. 001) levels were downregulated . Conclusion Dihydroartemisinin inhibits the growth , migration invasion and vasculogenic mimicry ability of non⁃small cell lung cancer cells

Objective: To explore the correlation between epidermal growth factor receptor ( EGFR) mutation and brain metastasis in lung adenocarcinoma． Methods: Comparisons of brain metastasis between lung adenocarcinoma patients with EGFR exon 19 deletion ( 19 Del) and a single point mutation of L858R in exon 21 (21 L858R) at initial diagnosis and after EGFR-TKIs targeted therapy were analyzed．The CCK-8 assay was used to detect and calculate the semi-inhibitory concentration (IC50 ) of gefitinib against EGFR-mutated lung adenoma cell lines PC9 and H3255 . Results: Of the 410 patients with lung adenocarcinoma，a total of 153 (37. 3% ) cases had brain metastasis．Age，lymph node metastasis and 21 L858R mutation were high-risk factors for brain metastasis of lung adenocarcinoma．Among newly diagnosed 48 EGFR-mutated lung adenocarcinoma patients with brain metastasis ，the number of 19 Del and 21 L858R were 14 and 34，respectively (P = 0. 006) ．There were 17 patients with 19 Del and 20 patients with 21 L858R were observed to complicated by brain metastasis after receiving EGFR-TKIs targeted therapy．The median time of brain metastasis after EGFR-TKIs treatment were 15 months (8. 50，25. 00) and 7 months (4. 25，12. 25 ) ，respectively ( P = 0. 013 ) ． The IC50 of PC9 and H3255 to gefitinib were (0. 037 ± 0. 008) and (0. 150 ± 0. 040) μmol / L，respectively (P = 0. 007) ． Conclusion Age younger than or equal to 60 years，lymph node N2-3 stage，and EGFR 21 L858R mutation are high-risk factors for brain metastases in patients with lung adenocarcinoma，and the latter still has a shorter time to brain metastases than 19 Del mutations after treatment with EGFR-TKIs，which may be related to drug sensitivity.

Objective : To investigate the expression and clinical significance of classic vascular endothelial growth factor A (VEGFA) and vasotropic mimicry factor matrix metalloproteinase 14 (MMP⁃14) in lung adenocarcinoma(LUAD) . Methods : The expression levels of MMP⁃14 and VEGFA genes and proteins in LUAD and their correlation with survival and prognosis were analyzed using TCGA and UALCAN databases . Serum of 69 patients with LUAD and 20 healthy subjects (control group) was collected , and the contents of MMP⁃14 and VEGFA were detected by ELISA and chemiluminescence , respectively , to analyze the correlation between the two and the clinicopathological features of tumors and their value in prediction and diagnosis of LUAD . Results: The levels of MMP⁃14 and VEGFA in LUAD tissues and serum were higher than those in control group . There were significant differences in serum VEGFA and MMP⁃14 expression levels among early stage group , advanced stage group and control group (P< 0. 001) . MMP⁃14 was higher in T3 /T4 stage than that in T1 /T2 stage (P = 0. 045) , higher in N2 /N3 stage than that in N0 /N1 stage (P = 0. 035) , and higher in the pleural metastasis group than that in the non⁃pleural metastasis group (P = 0. 034) . VEGFA level was higher in M 1 than M0 (P = 0. 025) . Elevated VEGFA level was a risk factor for LUAD (P = 0. 002) . The area under the curve (AUC) of MMP⁃14 , VEGFA and CEA alone was 0. 793 , 0. 849 and 0. 851 , respectively , and the AUC of the combined test was 0. 952 . The overall survival ( OS) and disease specific survival (DSS) of MMP⁃14 and VEGFA low expression group were longer than those of MMP⁃14 and VEGFA high expression group (P < 0. 05) . Conclusion High expression of MMP⁃14 and VEGFA in LUAD is associated with the growth , invasion and metastasis of LUAD , respectively , and has implications for survival prognosis determination .

Objective:To discuss the application effect of digital classroom based on identifying sectional structure in the experimental teaching of sectional anatomy.Methods:A total of 180 students majoring in imaging diagnosis from six classes of Batch 2018 in Mudanjiang Medical University were randomly selected as the research objects and divided into the experimental group and the control group. Three classes (90 people) in the experimental group implemented the digital classroom teaching of learning platform + virtual digital person, while another three classes (90 people) in the control group adopted traditional teaching. After the course, the effect was evaluated according to the results of the questionnaire and the final exam results. SPSS 18.0 software was used for t-test and Chi-square test. Results:The questionnaire showed that the students in the experimental groups were superior to those in the control group in self-study ability, independent thinking ability, analytical and problem-solving ability, learning efficiency, learning interest and sectional thinking cultivation, and the difference was statistically significant ( P<0.05). The test scores showed that the theoretical scores [(56.08±1.65) vs. (45.19±1.74)], experimental scores [(37.13±3.24) vs. (30.16±2.04)] and total scores [(93.21±3.18) vs. (75.35±1.79)] in the experimental group were higher than those in control group, and the differences were statistically significant ( P<0.05). Conclusion:The digital classroom based on identifying sectional structure is a feasible teaching mode, which improves the students' ability to analyze and solve problems, increases their interest in sectional anatomy, and improves the teaching effect.

Objective:To explore the module of the construction and application of medical first-aid at the door of the space capsule and the air evacuation.Methods:According to the purpose, principle, and method set by the module, it was divided into two sub-modules: medical first-aid at the door of the space capsule and the air evacuation. During the comprehensive first-aid training, independent training and combined training were carried out respectively according to different mission stages of launch and recovery and different recovery terrain. Meanwhile, research was performed to ensure that medical carrying equipment was lightweight, modular, and portable, and the efficiency of modularization construction was tested in the comprehensive training.Results:The module of medical first-aid at the door of the space capsule and the air evacuation obviously shortened the rescuing time during the comprehensive training, the saving effect was remarkable, and the overall saving efficiency was significantly improved.Conclusions:The module of medical first-aid at the door of the space capsule and the air evacuation meet the requirements that the emergency support system of aerospace medicine should function on an immediate basis, ensuring accurate treatment and air evacuation without any delay, so that to achieve the aim of aerospace medicare.