Impact of lymphatic and/or blood vessel invasion in stage Ⅱ gastric cancer

AIM:To determine the prognostic value of lymphatic and/or blood vessel invasion (LBVI) in patients with stage Ⅱ gastric cancer.METHODS:From January 2001 to December 2006,487 patients with histologically confirmed primary gastric adenocarcinoma were diagnosed with stage Ⅱ gastric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery,Fudan University Shanghai Cancer Center.All patients underwent curative gastrectomy with standard lymph node (LN) dissection.Fifty-one patients who died in the postoperative period,due to various complications or other conditions,were excluded.Clinicopathological findings and clinical outcomes were analyzed.Patients were subdivided into four groups according to the status of LBVI and LN metastases.These four patient groups were characterized with regard to age,sex,tumor site,pT category,tumor grading and surgical procedure (subtotal resection vs total resection),and compared for 5-year overall survival by univariate and multivariate analysis.RESULTS:The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years (range:23-88 years).The 5-year overall survival rates were 50.7% and the median survival time was 62 mo.Stage Ⅱ a cancer was observed in 334 patients,including 268 T3N0,63 T2N1,and three T1N2,and stage Ⅱb was observed in 102 patients,including 49 patients T3N1,51 T2N2,one T1N3,and one T4aN0.The incidence of LBVI was 28.0% in stage Ⅱ gastric cancer with 19.0% (51/269) and 42.5% (71/167) in LN-negative and LNpositive patients,respectively.In 218 patients (50.0%),there was neither a histopathologically detectable LBVI nor LN metastases (LBVI /LN ,group Ⅰ);in 51 patients (11.7%),LBVI with no evidence of LN metastases was detected (LBVI+/LN ,group Ⅱ).In 167 patients (38.3%),LN metastases were found.Among those patients,LBVI was not determined in 96 patients (22.0%) (LBVI /LN+,group Ⅲ),and was determined in 71 patients (16.3%) (LBVI+/LN+,group Ⅳ).Correlation analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI (P < 0.001).The overall 5-year survival was significantly longer in LN-negative patients compared with LN-positive patients (56.1% vs 42.3%,P = 0.015).There was a significant difference in the overall 5-year survival between LBVI-positive and LBVInegative tumors (39.6% vs 54.8%,P = 0.006).Overall 5-year survival rates in each group were 58.8% (Ⅰ),45.8% (Ⅱ),45.7% (Ⅲ) and 36.9% (Ⅳ),and there was a significant difference in overall survival between the four groups (P = 0.009).Multivariate analysis in stage Ⅱ gastric cancer patients revealed that LBVI independently affected patient prognosis in LN-negative patients (P = 0.018) but not in LN-positive patients (P = 0.508).CONCLUSION:In LN-negative stage Ⅱ gastric cancer patients,LBVI is an additional independent prognostic marker,and may provide useful information to identify patients with poorer prognosis.

Development and Validation of a Simplified Chinese Version of the Assessment Tool for Students' Perceptions of Medical Professionalism

Professionalism is crucial in all professions and is particularly important in the medical field.Measuring students' perceptions of professionalism can help to form education targeting the enhancement of professionalism.This study aimed to validate an effective assessment tool for the measurement of medical students5 perceptions of medical professionalism in China's Mainland.The cross-sectional survey was conducted in three medical colleges in Guangdong,China.Of the 2103 eligible medical students,1976 responded,and 1856 questionnaires were deemed valid.Students from clinical medicine in these three medical colleges were randomly selected by cluster sampling.First,a Simplified Chinese Version questionnaire to measure Student's Perception of Medical Professionalism (SCV-SPMP) was constructed.Second,questionnaires from 1856 students majoring in clinical medicine at three medical colleges were included in the analysis.Third,exploratory factor analysis,Cronbach's alpha,item-subscale correlation,and confirmatory factor analysis were conducted to test the validity and reliability of the SCV-SPMP.Nine items were eliminated following exploratory factor analysis,and four subscales were extracted from the analysis.All internal consistency reliability exceeded the minimum standard.The overall Cronbach's alpha was 0.94,and four subscales' alphas were 0.82 (Accountability and excellence),0.81 (Duty),0.89 (Honor and integrity),and 0.85 (Practice habits and respect for others),respectively.The model fit was good.The convergent validity and discriminant validity were acceptable.The modified SCVSPMP was found to be a valid and reliable tool to capture the main features of Chinese students' perceptions of medical professionalism in four dimensions,and it provides a quantitative method for the measurement of the students' perceptions in China's Mainland..

Mechanism of edaravone combined with urinary kallidinogenase for acute cerebral infarction patients

Objective:To observe the effects of edaravone combined with urinary kallidinogenase on serum ox-LDL, PCT, hs-CRP, TNF-α and T cell subsets in patients with acute cerebral infarction, so as to explore the mechanisms of combination therapy on patients with acute cerebral infarction. Methods:86 cases of patients with acute cerebral infarction in our hospital from March 2014 to May 2016 were randomly divided into two groups:control group and observation group, 43 cases in each group. All patients were given general treatment according to their own specific conditions, including hypoglycemic, pressure adjustment, prevention and treatment of complications, symptomatic support therapy, etc. The control group were given 30 mg Edaravone Injection on this basis with once per day for 14 d;The observation group was treated with 0. 15 PNA urinary kallidinogenase intravenous drip with once per day for 14 d on the basis of the control group. The levels of serum x-LDL, PCT, hs-CRP, TNF-αand CD3+, CD4+, CD8+, CD4+/CD8+were detected and compared between the two groups. Results:(1) Before treatment, there was no significant difference between the two groups on the levels of serum ox-LDL, PCT, hs-CRP, and TNF-α;after treatment, the serum levels of ox-LDL, PCT, hs-CRP and TNF-αin the two groups were significantly lower than that before treatment, and the difference was significant (P<0.05);(2) Before treatment, there was no significant difference between the two groups on the levels of serum CD3+, CD4+, CD8+, CD4+/CD8+;after treatment, the serum levels of CD3+, CD4+and CD4+/CD8+were significantly increased in the two groups, and the level of CD8+was significantly decreased compared with the same group before treatment, and the difference was significant (P<0.05);and the levels of serum CD3+, CD4+, CD8+and CD4+/CD8+in the observation group were significantly better than those in the control group, and the difference was significant (P<0.05). Conclusions:The treatment of combined application of urinary kallidinogenase and edaravone in patients with acute cerebral infarction, can significantly improve the serum levels of ox-LDL, PCT, hs-CRP, TNF-αand T cell subsets, further illustrates the synergistic effect of the combination, also shows that the two drugs for acute cerebral infarction can inhibit thrombosis to expand, reduce inflammation, relieve cerebral tissue damage, and improve neurological function.

Exchange of Proton and Major Elements in Two-Layer Canopies Under Acid Rain in a Subtropical Evergreen Forest in Central-South China

Canopy exchanges of H^＋ and N （NH4^＋-N, NO3^--N） and other major ions were evaluated and quantified In twolayer canopies based on throughfall measurements in Shaoshan Forest during the period 2000-2002, central-south China, The collected annual rainfall, throughfall, and sub-throughfall were 1 401, 1 191, and 1 084 mm/year, respectively. Fifteen percent and 8% of rainfall （or 9% of throughfall） were intercepted by the top canopy and sub-canopy layers, respectively, The foliar leaching of base cations from the top canopy was significantly higher than that from the sub-canopy, and the latter accounted for 25% of the former. The uptake of H^＋ and NH4^＋ was significantly higher in the top canopy than in the sub-canopy, indicating that the canopy buffering capacity in the top canopy was stronger than the sub-canopy; Mg^2＋ can be absorbed from water flux on the sub-canopy foliar surfaces to compensate for the Mg deficit in the forest soil during the growing season,