Incorporation of perigastric tumor deposits into the TNM staging system for primary gastric cancer

BACKGROUND The current prognostic significance of perigastric tumor deposits(TDs)in gastric cancer(GC)remains unclear.AIM To assess the prognostic value of perigastric TDs and put forward a new TNM staging framework involving TDs for primary GC.METHODS This study retrospectively analyzed the pathological data of 6672 patients with GC who underwent gastrectomy or surgery for GC with other diseases from January 1,2012 to December 31,2017 at the Chinese PLA General Hospital.According to the presence of perigastric TDs or not,the patients were divided into TD-positive and TD-negative groups by using the method of propensity score matching.The differences between TD-positive and TD-negative patients were analyzed using binary logistic regression modeling.The Kaplan-Meier method was used to plot survival curves.Multivariate Cox regression modeling and the log-rank test were used to analyze the data.RESULTS Perigastric TDs were found to be positive in 339(5.09%)of the 6672 patients with GC,among whom 237 were men(69.91%)and 102 were women(30.09%)(2.32:1).The median age was 59 years(range,27 to 78 years).Univariate and multivariate survival analyses indicated that TD-positive GC patients had a poorer prognosis than TD-negative patients(P<0.05).The 1-,3-,and 5-year overall survival rates of GC patients with TDs were 68.3%,19.6%,and 11.2%,respectively,and these were significantly poorer than those without TDs of the same stages.There was significant variation in survival according to TD locations among the GC patients(P<0.05).A new TNM staging framework for GC was formulated according to TD location.When TDs appear in the gastric body,the original stages T1,T2,and T3 are classified as T4a with the new framework,and the original stages T4a and T4b both are classified as T4b.When TDs appear in the lesser curvature,the previous stages N0,N1,N2,and N3 now both are classified as N3.When TDs appear in the greater curvature or the distant tissue,the patient should be categorized as having M1.With the new GC staging scheme including TDs,the survival curves of patients in the lower grade TNM stage with TDs were closer to those of patients in the higher grade TNM stage without TDs.CONCLUSION TDs are a poor prognostic factor for patients with primary GC.The location of TDs is associated with the prognosis of patients with primary GC.Accordingly,we developed a new TNM staging framework involving TDs that is more appropriate for patients with primary GC.

Prognostic value of 11-factor modified frailty index in postoperative adverse outcomes of elderly gastric cancer patients in China

BACKGROUND Preoperative evaluation of frailty is limited to a few surgical procedures.However,the evaluation in Chinese elderly gastric cancer(GC)patients remains blank.AIM To validate and estimate the prognostic value of the 11-index modified frailty index(mFI-11)for predicting postoperative anastomotic fistula,intensive care unit(ICU)admission,and long-term survival in elderly patients(over 65 years of age)undergoing radical GC.METHODS This study was a retrospective cohort study which included patients who underwent elective gastrectomy with D2 Lymph node dissection between April 1,2017 and April 1,2019.The primary outcome was 1-year all-cause mortality.The secondary outcomes were admission to ICU,anastomotic fistula,and 6-mo mortality.Patients were divided into two groups according to the optimal grouping cutoff of 0.27 points from previous studies:High risk of frailty marked as mFI-11High and low risk of frailty marked as mFI-11Low.Survival curves between the two groups were compared,and univariate and multivariate regression analyses were performed to explore the relationship between preoperative frailty and postoperative complications in elderly patients undergoing radical GC.The discrimination ability of the mFI-11,prognostic nutritional index,and tumornode-metastasis pathological stage to identify adverse postoperative outcomes was assessed by calculating the area under the receiver operating characteristic(ROC)curve.RESULTS A total of 1003 patients were included,of which 13.86%(139/1003)were defined as having mFI-11High and 86.14%(864/1003)as having mFI-11Low.By comparing the incidence of postoperative complications in the two groups of patients,it was found that mFI-11High patients had higher rates of 1-year postoperative mortality,admission to ICU,anastomotic fistula,and 6-mo mortality than the mFI-11Low group(18.0%vs 8.9%,P=0.001;31.7%vs 14.7%,P<0.001;7.9%vs 2.8%,P<0.001;and 12.2%vs 3.6%,P<0.001).Multivariate analysis revealed mFI-11 as an independent predictive indicator for postoperative outcome[1-year postoperative mortality:Adjusted odds ratio(aOR)=4.432,95%confidence interval(95%CI):2.599-6.343,P=0.003;admission to ICU:aOR=2.058,95%CI:1.188-3.563,P=0.010;anastomotic fistula:aOR=2.852,95%CI:1.357-5.994,P=0.006;6-mo mortality:aOR=2.438,95%CI:1.075-5.484,P=0.033].mFI-11 showed better prognostic efficacy in predicting 1-year postoperative mortality[area under the ROC curve(AUROC):0.731],admission to ICU(AUROC:0.776),anastomotic fistula(AUROC:0.877),and 6-mo mortality(AUROC:0.759).CONCLUSION Frailty as measured by mFI-11 could provide prognostic information for 1-year postoperative mortality,admission to ICU,anastomotic fistula,and 6-mo mortality in patients over 65 years old undergoing radical GC.

Potential of dental pulp stem cells and their products in promoting peripheral nerve regeneration and their future applications

Peripheral nerve injury(PNI)seriously affects people’s quality of life.Stem cell therapy is considered a promising new option for the clinical treatment of PNI.Dental stem cells,particularly dental pulp stem cells(DPSCs),are adult pluripotent stem cells derived from the neuroectoderm.DPSCs have significant potential in the field of neural tissue engineering due to their numerous advantages,such as easy isolation,multidifferentiation potential,low immunogenicity,and low transplant rejection rate.DPSCs are extensively used in tissue engineering and regenerative medicine,including for the treatment of sciatic nerve injury,facial nerve injury,spinal cord injury,and other neurodegenerative diseases.This article reviews research related to DPSCs and their advantages in treating PNI,aiming to summarize the therapeutic potential of DPSCs for PNI and the underlying mechanisms and providing valuable guidance and a foundation for future research.

Timing of surgery after neoadjuvant chemotherapy for gastric cancer: Impact on outcomes

AIM To evaluate whether the neoadjuvant chemotherapy(NAc T)-surgery interval time significantly impacts the pathological complete response(pc R) rate and longterm survival.METHODS One hundred and seventy-six patients with gastric cancer undergoing NAc T and a planned gastrectomy at the chinese p LA General hospital were selected from January 2011 to January 2017. Univariate and multivariable analyses were used to investigate the impact of NAc T-surgery interval time(< 4 wk, 4-6 wk, and > 6 wk) on pc R rate and overall survival(OS).RESULTS The NAc T-surgery interval time and clinician T stage were independent predictors of pc R. The interval time > 6 wk was associated with a 74% higher odds of pc R as compared with an interval time of 4-6 wk(p = 0.044), while the odds ratio(OR) of clinical T3 vs clinical T4 stage for pc R was 2.90(95%c I: 1.04-8.01, p = 0.041). In cox regression analysis of long-term survival, postneoadjuvant therapy pathological N(yp N) stage significantly impacted OS(N0 vs N3: h R = 0.16, 95%c I: 0.37-0.70, p = 0.015; N1 vs N3: h R = 0.14, 95%c I: 0.02-0.81, p = 0.029) and disease-free survival(DFS)(N0 vs N3: h R = 0.11, 95%c I: 0.24-0.52, p = 0.005; N1 vs N3: h R = 0.17, 95%c I: 0.02-0.71, p = 0.020). The surgical procedure also had a positive impact on OS and DFS. The hazard ratio of distal gastrectomy vs total gastrectomy was 0.12(95%c I: 0.33-0.42, p = 0.001) for OS, and 0.13(95%c I: 0.36-0.44, p = 0.001) for DFS.CONCLUSION The NAc T-surgery interval time is associated with pc R but has no impact on survival, and an interval time > 6 wk has a relatively high odds of pc R.

Effect of postoperative early enteral nutrition on clinical outcomes and immune function of cholangiocarcinoma patients with malignant obstructive jaundice

BACKGROUND Most cholangiocarcinoma patients with malignant obstructive jaundice(MOJ)have varying degrees of malnutrition and immunodeficiency preoperatively.Therefore,perioperative nutritional support has important clinical significance in the treatment of cholangiocarcinoma.AIM To investigate the effects of postoperative early enteral nutrition(EEN)on immunity function and clinical outcomes of cholangiocarcinoma patients with MOJ.METHODS This prospective clinical study included 60 cholangiocarcinoma patients with MOJ who underwent surgery.The patients were randomly divided into an experimental group and a control group according to the nutrition support modes.The control group received postoperative total parenteral nutrition(TPN),whereas the experimental group received postoperative EEN and parenteral nutrition(PN;EEN+PN).The clinical outcomes,postoperative immune function,incidences of surgical site infection and bile leakage,intestinal function recovery time,average hospitalization days,and hospitalization expenses of the two groups were assessed on postoperative days(PODs)1,3,and 7.RESULTS The CD3+T,CD4+T,CD8+T,and CD4+T/CD8+T cell count and the immunoglobulin(Ig)G,IgM,and IgA levels in the EEN+PN group were significantly higher than those in the TPN group on PODs 3 and 7(P<0.05),whereas no significant differences in the CD3+T,CD4+T,CD8+T,and CD4+T/CD8+T cell counts and IgG,IgM,and IgA levels before operation and on POD 1 were found between the two groups(P>0.05).The intestinal function recovery time and postoperative hospital stay were shorter(P<0.001 for both)in the EEN+PN group than in the TPN group.The hospitalization expenses of the EEN+PN group were lower than those of the TPN group(P<0.001).However,the incidence of abdominal distension was higher than in the EEN+PN group than in the TPN group(P<0.05).The incidence rates of biliary leakage and surgical site infection were not significantly different between the two groups(P>0.05).CONCLUSION A postoperative EEN program could reduce the incidence of postoperative complications and improve the clinical outcomes and immune functions of cholangiocarcinoma patients with MOJ and is thus beneficial to patient recovery.

Role of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer

BACKGROUND Gastric cancer is the second most common malignant tumor in China,ranking third among all malignant tumor mortality rates.Hyperthermic intraperitoneal chemotherapy(HIPEC)has been shown to increase significantly the effectiveness of intraperitoneal chemotherapeutic drugs,prolong the action time of these drugs on intraperitoneal tumor cells,and enhance their diffusion in tumor tissues.HIPEC may be one of the best choices for the eradication of residual cancer cells in the abdominal cavity.AIM The aim of this study was to study the role of preventive HIPEC after radical gastrectomy.METHODS A prospective analysis was performed with patients with c T4 N0-3 M0 gastric cancer to compare the effects of postoperative prophylactic HIPEC plus intravenous chemotherapy with those of routine adjuvant chemotherapy.Patients’medical records were analyzed,and differences in the peritoneal recurrence rate,diseasefree survival time,and total survival time between groups were examined.RESULTS The first site of tumor recurrence was the peritoneum in 11 cases in the conventional adjuvant chemotherapy group and in 2 cases in the HIPEC group(P=0.020).The 1-year and 3-year disease-free survival rates were 91.9%and 60.4%,respectively,in the conventional adjuvant chemotherapy group and 92.1%and 63.0%,respectively,in the HIPEC group.The 1-year and 3-year overall survival rates were 95.2%and 66.3%,respectively,in the conventional adjuvant chemotherapy group and 96.1%and 68.6%,respectively,in the HIPEC group.No significant difference in postoperative or chemotherapy complications was observed between groups.CONCLUSION In patients with c T4 N0-3 M0 gastric cancer,prophylactic HIPEC after radical tumor surgery is beneficial to reduce peritoneal tumor recurrence and prolong survival.

Effects of early oral feeding after radical total gastrectomy in gastric cancer patients

BACKGROUND Gastric cancer(GC)is a heavy burden in China.Nutritional support for GC patients is closely related to postoperative rehabilitation.However,the role of early oral feeding after laparoscopic radical total gastrectomy in GC patients is unclear and high-quality research evidence is scarce.AIM To prospectively explore the safety,feasibility and short-term clinical outcomes of early oral feeding after laparoscopic radical total gastrectomy for GC patients.METHODS This study was a prospective cohort study conducted between January 2018 and December 2019 based in a high-volume tertiary hospital in China.A total of 206 patients who underwent laparoscopic radical total gastrectomy for GC were enrolled.Of which,105 patients were given early oral feeding(EOF group)after surgery,and the other 101 patients were given the traditional feeding strategy(control group)after surgery.Perioperative clinical data were recorded and analyzed.The primary endpoints were gastrointestinal function recovery time and postoperative complications,and the secondary endpoints were postoperative nutritional status,length of hospital stay and expenses,etc.RESULTS Compared with the control group,patients in the EOF group had a significantly shorter postoperative first exhaust time(2.48±1.17 d vs 3.37±1.42 d,P=0.001)and first defecation time(3.83±2.41 d vs 5.32±2.70 d,P=0.004).In addition,the EOF group had a significant shorter postoperative hospitalization duration(5.85±1.53 d vs 7.71±1.56 d,P<0.001)and lower postoperative hospitalization expenses(16.60±5.10 K¥vs 21.00±7.50 K¥,P=0.014).On the 5th day after surgery,serum prealbumin level(214.52±22.47 mg/L vs 204.17±20.62 mg/L,P=0.018),serum gastrin level(246.30±57.10 ng/L vs 223.60±55.70 ng/L,P=0.001)and serum motilin level(424.60±68.30 ng/L vs 409.30±61.70 ng/L,P=0.002)were higher in the EOF group.However,there was no significant difference in the incidence of total postoperative complications between the two groups(P=0.507).CONCLUSION Early oral feeding after laparoscopic radical total gastrectomy can promote the recovery of gastrointestinal function,improve postoperative nutritional status,reduce length of hospital stay and expenses while not increasing the incidence of related complications,which indicates its safety,feasibility and potential benefits for gastric cancer patients.

Does the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopic-assisted distal gastrectomy benefit patients?

BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy.Braun anastomosis is usually performed after Billroth Ⅱ reconstruction,which is wildly applied on distal gastrectomy because it is believed to benefit patients.However,studies are needed to confirm that.AIM To identify whether the addition of Braun anastomosis to Billroth Ⅱ reconstruction on laparoscopy-assisted distal gastrectomy benefits patients.METHODS A total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019.Clinical data of the patients were collected,and 93 of the 143 patients were followed up.These 93 patients were divided into two groups:Group 1(Billroth Ⅱ reconstruction,33 patients);and Group 2(Billroth Ⅱ reconstruction combined with Braun anastomosis,60 patients).Postoperative complication follow-up data and relevant clinical data were compared between the two groups.RESULTS There were no significant differences between Group 1 and Group 2 in postoperative complications(6.1%vs 6.7%,P=0.679),anal exhaust time or blood loss.The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2(68.2%vs 51.7%,P=0.109).The followup European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well.Group 1 had a shorter operating time than Group 2 on average(234.6 min vs 262.0 min,P=0.017).CONCLUSION Combined with Billroth Ⅱ reconstruction,Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis.Whereas in this study,the prevalence of reflux gastritis showed no significant difference,leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money,simple Billroth Ⅱ reconstruction should be widely applied.

Laparoscopic-assisted vs open transhiatal gastrectomy for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction: A retrospective cohort study

BACKGROUND The studies of laparoscopic-assisted transhiatal gastrectomy(LTG) in patients with Siewert type Ⅱ adenocarcinoma of the esophagogastric junction(AEG) are scarce.AIM To compare the surgical efficiency of LTG with the open transhiatal gastrectomy(OTG) for patients with Siewert type Ⅱ AEG.METHODS We retrospectively evaluated a total of 578 patients with Siewert type Ⅱ AEG who have undergone LTG or OTG at the First Medical Center of the Chinese People’s Liberation Army General Hospital from January 2014 to December 2019. The short-term and long-term outcomes were compared between the LTG(n = 382) and OTG(n = 196) groups.RESULTS Compared with the OTG group, the LTG group had a longer operative time but less blood loss, shorter length of abdominal incision and an increased number of harvested lymph nodes(P < 0.05). Patients in the LTG group were able to eat liquid food, ambulate, expel flatus and discharge sooner than the OTG group(P < 0.05). No significant differences were found in postoperative complications and R0 resection. The 3-year overall survival and disease-free survival performed better in the LTG group compared with that in the OTG group(88.2% vs 79.2%, P = 0.011;79.7% vs 73.0%, P = 0.002, respectively). In the stratified analysis, both overall survival and disease-free survival were better in the LTG group than those in the OTG group for stage Ⅱ/Ⅲ patients(P < 0.05) but not for stage I patients.CONCLUSION For patients with Siewert type Ⅱ AEG, LTG is associated with better short-term outcomes and similar oncology safety. In addition, patients with advanced stage AEG may benefit more from LTG in the long-term outcomes.

Giant hemangioma of the caudate lobe of the liver with surgical treatment:A case report

BACKGROUND Caudate lobe hemangioma of the liver is relatively rare.Due to the unique anatomical location of the caudate lobe,the caudate lobectomy accounts for only 0.5%to 4%of hepatic resection,which is difficult to operate and takes a long time,and even has many postoperative complications.CASE SUMMARY A 34-year-old female presented with a 1 year history of intermittent pain in the right side of the waist without obvious inducement.All laboratory blood tests were within normal limits.Indocyanine green 15 min retention was rated 2.9%,and Child-Pugh was rated A.Computed tomography and magnetic resonance imaging diagnosed giant hemangioma of the caudate lobe with hemangioma of left lobe of liver.After discussion,surgical treatment was performed,which lasted 410 min,with intraoperative bleeding of about 600 mL and postoperative pathological findings of cavernous hemangioma.There were no obvious postoperative complications,and the patient was discharged 10 d after surgery.CONCLUSION Caudate lobectomy is difficult due to its special anatomical location.Under the condition of fully exposing the anatomy of the first porta hepatis,the second porta hepatis,the third porta hepatis,the fourth porta hepatis and middle hepatic vein and combining with the Pringle maneuver,caudate lobectomy can be performed in a precise and safe process.

Conductivity and band alignment of LaCrO_3/SrTiO_3(111) heterostructure

In this work,we investigate the electrical transport property and electronic structure of oxide heterostructure LaCrO3/SrTiO3（111）.The interface grown under relatively low oxygen partial pressure is found to be metallic with a conducting critical thickness of 11 unit cells of LaCrO3.This criticality is also observed by x-ray photoelectron spectroscopy,in which the Ti^3＋ signal intensity at the spectrum edge of the Ti-2p（3/2） core level increases rapidly when the critical thickness is reached.The variations of the valence band offset and full width at half maximum of the core-level spectrum with LaCrO3 thickness suggest that the built-in fields exist both in LaCrO3 and in SrTiO3.Two possible origins are proposed：the charge transfer from LaCrO3 and the formation of a quantum well in SrTiO3.Our results shed light on the understanding of the doping mechanism at the polar/non-polar oxide interface.Moreover,due to the interesting lattice and spin structure of LCO in the（111） direction,our work provides a basis for further exploring the novel topological quantum phenomena in this system.

Influence of HBcAg in liver cell plasma on expression of transforming growth factor-beta 1 in liver tissue of low-grade chronic hepatitis B patients

AIM： To study the influence of HBcAg on the expression of transforming growth factor-beta 1 （TGF-131） in liver tissue of low-grade chronic hepatitis B （CHB） patients. METHODS： The expression of T（3F-β1 and HBcAg in liver samples from 93 low-grade CHB patients was detected by immunohistochemistry and valuated by semi-quantitative scoring. RESULTS： In the 93 low-grade CHB patients, HBcAg was expressed in cell plasma but not in the liver tissue. There was no significant difference between the two groups. CONCLUSION： The expression of TGF-β1 is not related with HBcAg expressed as plasma type in the tissues of low-grade CHB patients.

Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor:A case report

BACKGROUND Duodenal papillary tumor is a rare tumor of the digestive tract,accounting for about 0.2%of gastrointestinal tumors and 7%of periampullary tumors.The clinical manifestations of biliary obstruction are most common.Some benign tumors or small malignant tumors are often not easily found because they have no obvious symptoms in the early stage.Surgical resection is the only treatment for duodenal papillary tumors.At present,the methods of operation for duodenal papillary tumors include pancreatoduodenectomy,duodenectomy,ampullectomy,and endoscopic resection.CASE SUMMARY A 47-year-old man was admitted to because of a duodenal mass that had been discovered 2 mo previously.Electronic gastroscopy at another hospital revealed a duodenal papillary mass that had been considered to be a high-grade intraepithelial neoplasia.Therefore,we conducted a multidisciplinary group discussion and decided to perform a pancreas-preserving duodenectomy and a R0 resection was successfully performed.After surgery,the patient underwent a follow-up period of 5 yr.No recurrence or metastasis occurred.CONCLUSION According to our experience with a duodenal papillary tumor,compared with pancreaticoduodenectomy,the use of pancreas-preserving duodenectomy can preserve pancreatic function,maintain gastrointestinal structure and function,reduce tissue damage and complications,and render the postoperative recovery faster.Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor is feasible under strict control of surgical indications.

Emergency surgical workflow and experience of suspected cases of COVID-19: A case report

BACKGROUND Severe acute respiratory syndrome coronavirus 2 has been confirmed to be a newly discovered zoonotic pathogen that causes highly contagious viral pneumonia,which the World Health Organization has named novel coronavirus pneumonia.Since its outbreak,it has become a global pandemic.During the outbreak of coronavirus disease 2019(COVID-19),however,there is no mature experience or guidance on how to carry out emergency surgery for suspected cases requiring emergency surgical intervention and perioperative safety protection against virus.CASE SUMMARY A 41-year-old man was admitted to the hospital for emergency treatment due to"3-d abdominal pain aggravated with cessation of exhaust and defecation".After improving inspections and laboratory tests,the patient was assessed and diagnosed by the multiple discipline team as"strangulation obstruction,pulmonary infection”.His body temperature was 38.8℃,and the chest computed tomography showed pulmonary infection.Given fever and pneumonia,we could not rule out COVID-19 after consultation by fever clinicians and respiratory experts.Hence,we performed emergency surgery under three-level protection for the suspected case.After surgery,his nucleic acid test for COVID-19 was negative,meaning COVID-19 was excluded,and routine postoperative treatment and nursing was followed.The patient was treated with symptomatic support after the operation.The stomach tube and urinary tube were removed on the 1st d after the operation.The clearing diet was started on the 3rd d after the operation,and the body temperature returned to normal.Flatus and bowel movements were noted on 5th postoperative day.He was discharged after 8 d of hospitalization.The patient was followed up for 4 mo after discharge,no serious complications occurred.A 71-year-old woman was admitted to our emergency room due to"abdominal distention,fatigue for 6 d and fever for 13 h".After the multiple discipline team evaluation,the patient was diagnosed as"intestinal obstruction,abdominal mass,peritonitis and pulmonary infection".At that time,the patient's body temperature was 39.6℃,and chest computed tomography indicated pulmonary infection.COVID-19 could not be completely excluded after consultation in the fever outpatient department and respiratory department.Therefore,the patient was treated as a suspected case,and an urgent operation was performed under three-level medical protection.Postoperative nucleic acid test was negative,COVID-19 was excluded,and routine postoperative treatment and nursing were followed.After the operation,the patient received symptomatic and supportive treatment.The gastric tube was removed on the 1st d after the operation,and the urinary tube was removed on the 3rd d after the operation.Enteral nutrition began on the 3rd d after the operation.To date,no serious complications have been found during follow-up after discharge.CONCLUSION Based on the previous treatment experience,we reviewed the procedures of two cases of suspected COVID-19 emergency surgery and extracted the perioperative protection experience.By referring to the literature and following the regulations on prevention and management of infectious diseases,we have developed a relatively mature and complete emergency surgical workflow for suspected COVID-19 cases and shared perioperative protection and management experience and measures.

3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study

BACKGROUND Three-dimensional(3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach(CRS), but its clinical efficacy remains controversial.AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy(3DLAG) with open gastrectomy(OG) for CRS.METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up,we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival(OS) rates were compared between the two groups.RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score,initial disease state(benign or malignant), primary surgical anastomosis method,interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss(188.33 ± 191.35 mL vs 305.83 ± 303.66 mL;P =0.045) and smaller incision(10.86 ± 3.18 cm vs 20.06 ± 5.17 cm;P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG(14.0 ± 7.17 vs 10.73 ± 6.82;P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups(1.56 ± 2.84 vs 2.35 ± 5.28;P = 0.413). The complication rate(8.3% vs 20.8%;P = 0.207) and intensive care unit admission rate(5.6% vs 14.5%;P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval(CI): 72.4%-95.6%] and 73.3%(95%CI: 60.0%-89.5%)respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3%(95%CI: 76.4%-99.8%) and 75.6%(95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups(P = 0.68).CONCLUSION Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.

Graphene oxide/Al_(2)O_(3)-based diffusive memristor cells:enabling robust crossbar arrays for multidisciplinary applications

A memristor crossbar array (MCA) has emerged as a cutting-edge platform for advanced memory and neuromorphic computing hardware,offering unrivaled bit-level storage density.A diffusive memristor cell (DMC) is particularly well-suited for MCA integration due to its inherent threshold switching characteristics as a selector,effectively addressing current sneak path issues.Although DMC's potential is acknowledged,it necessitates furtherexploration of their practical applicability.

氨基碳纳米管/DOPO衍生物的协效阻燃及其对尼龙6性能的影响

将DOPO衍生物(DIDOPO)和氨基碳纳米管(MWCNTs)以一定的比例进行复配,添加到尼龙6(PA6)中熔融共混制得复合材料.运用万能试验机、热重分析仪、示差扫描量热仪、锥形量热仪及扫描电镜测试了各样本的力学性能、热稳定性、结晶性以及燃烧性能,并观察了炭层形貌.测试结果表明,加入MWCNTs后,复合材料的拉伸强度显著增强,与PA6/DIDOPO复合材料相比,其拉伸强度平均提升了55%.从非等温结晶曲线可以看出,加入MWCNTs后PA6复合材料的结晶初始温度(Tonset)和结晶峰温(Tc)都有明显提高,但由于MWCNTs的异相成核作用,结晶度降低.此外,锥形量热测试表明,当MWCNTs的添加量为2 wt%时,其热释放速率峰值(PHRR)为367.28 kW/m2,较纯PA6降低了58.9%.扫描电镜和拉曼测试分析表明MWCNTs的加入促进了致密结构炭层的形成,与DIDOPO有协效阻燃的作用.

An active method suppressing rolling mill vibration: disturbance estimation and compensation algorithm

The rolling mill vibration not only seriously causes the strip thickness heterogeneity, but also damages the rolling mill equipment and its electrical components. Existing vibration suppression methods are passive and mainly tune mechanical, hydraulic, electrical and rolling process parameters. A new active vibration suppression method was thus proposed using the disturbance estimation and compensation algorithm. Firstly, the hydraulic-mechanical coupling model of the rolling mill vibration was established, and an active vibration suppressor was designed based on the extended state observer. Then, through the numerical simulation, it is found that the vibration energy is reduced by 35.3% using the vibration suppressor, and the vibration suppressor is valid when the vibration frequency is lower than 60 Hz Finally, the vibration suppressor was applied to the in-site manufacturing, and the expected vibration suppression was obtained. The method makes the produced steel strip have more uniform thickness and further significantly increases the finished product ratio.

Influence of mill modulus control gain on vibration in hot rolling mills

The rolling mill vibration is characterized by the coupling effects among mechanical,electrical,hydraulic and interfacial subsystems.The influence of the mill modulus control gain in automatic gauge control on the vibration in hot rolling mills was investigated.Firstly,an experiment related to the mill modulus control gain was carried out in the hot rolling mill process,and it was found that the rolling mill vibration increases with the mill modulus control gain.Then,based on the Sims rolling force method,the coupling dynamic model was established to explain this phenomenon.Finally,the influence of mill modulus control gain on the vibration was analyzed numerically on the basis of the coupling dynamic model.Moreover,the agreement between the experimental results and the simulation results was confirmed and the measure reducing the mill modulus control gain was obtained to relieve mill vibration.

Investigating the Nucleation Effect of DMDBS on Syndiotactic Polypropylene from the Perspective of Chain Conformation

The mechanism of nucleating agents(NAs)accelerating the crystallization of semi-crystlline polymers has received continuous attention due to the extreme importance in academic research and industry application.In this work,the nucleation effect and probable mechanism of 1,3.2,4 bis(3,4-dimethylbenzylidene)sorbitol(DMDBS)on promoting the crystallization of syndiotactic polypropylene(sPP)was systematically investigated.Our results showed that DMDBS could significantly accelerate the crystallization process and did not change the crystalline form of sPP.The in situ infrred spectra recorded in the crystallization process showed that in pristine sPP the tttt conformers decreased and the tgg conformers increased subsequently.In sPP/DMDBS system,DMDBS could promote the increase of tgg conformers rather than the decrease of tttt conformers.The further analysis by 2D-IR spectra revealed that ttgg conformers increased prior to the decrease of tttt conformers in the sPP/DMDBS system comparing with pristine sPP.Considering that ttgg conformers were basic elements of helical conformation of Form I crystal for sPP,we proposed a probable nucleation mechanism of DMDBS for sPP:DMDBS could stabilize the ttgg conformers which induced these ttgg conformers to pre-orientate and aggregate into helical conformation sequences as initial nuclei quickly and early to promote the sPP crystallization.Our work provides some new insights into the nucleation mechanism of NAs for sPP.