Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer

BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery,guide perioperative treatment strategies for gastric cancer patients,and prevent serious complications.METHODS In total,998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model,and 398 patients were included in the validation group.The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected.Three machine learning methods,lasso regression,random forest,and artificial neural networks,were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy,and their prediction efficacy and accuracy were evaluated.RESULTS The constructed complication model,particularly the random forest model,could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy.It exhibited stable performance in external validation and is worthy of further promotion in more centers.CONCLUSION Using the risk factors identified in multicenter datasets,highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established.We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.

Analysis of the Impact of Digital Transformation on Non-Financial Performance of Manufacturing Enterprises

As one of the important pillars of China’s national economy,the development of the manufacturing industry has attracted much attention.The manufacturing industry has become a key development area due to its high technology content,capital-intensive,knowledge-intensive,and many more characteristics.With the rapid development of big data information technology,emerging technologies such as artificial intelligence have brought a lot of convenience to people’s lives,and manufacturing enterprises have also realized the importance of reform and innovation,and have begun to carry out digital transformation.Based on the study of the motivation of digital transformation of manufacturing enterprises,this paper explores the transformation path of manufacturing enterprises to meet the needs of social development,and deeply analyzes the impact of digital transformation of manufacturing enterprises on enterprise performance,with a view to improving the unbalanced industrial structure and lagging technological development at the present stage through digital transformation.

A super wear-resistant coating for Mg alloys achieved by plasma electrolytic oxidation and discontinuous deposition

Magnesium alloys are lightweight materials with great potential,and plasma electrolytic oxidation(PEO)is effective surface treatment for necessary improvement of corrosion resistance of magnesium alloys.However,the∼14µm thick and rough PEO protection layer has inferior wear resistance,which limits magnesium alloys as sliding or reciprocating parts,where magnesium alloys have special advantages by their inherent damping and denoising properties and attractive light-weighting.Here a novel super wear-resistant coating for magnesium alloys was achieved,via the discontinuous sealing(DCS)of a 1.3µm thick polytetrafluoroethylene(PTFE)polymer layer with an initial area fraction(A_(f))of 70%on the necessary PEO protection layer by selective spraying,and the wear resistance was exceptionally enhanced by∼5500 times in comparison with the base PEO coating.The initial surface roughness(Sa)under PEO+DCS(1.54µm)was imperfectly 59%higher than that under PEO and conventional continuous sealing(CS).Interestingly,DCS was surprisingly 20 times superior for enhancing wear resistance in contrast to CS.DCS induced nano-cracks that splitted DCS layer into multilayer nano-blocks,and DCS also provided extra space for the movement of nano-blocks,which resulted in rolling friction and nano lubrication.Further,DCS promoted mixed wear of the PTFE polymer layer and the PEO coating,and the PTFE layer(HV:6 Kg·mm^(−2),A_(f):92.2%)and the PEO coating(HV:310 Kg·mm^(−2),A_(f):7.8%)served as the soft matrix and the hard point,respectively.Moreover,the dynamic decrease of Sa by 29%during wear also contributed to the super wear resistance.The strategy of depositing a low-frictional discontinuous layer on a rough and hard layer or matrix also opens a window for achieving super wear-resistant coatings in other materials.

Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.

Anatomical variation of infra-pyloric artery origination： A prospective multicenter observational study (IPA-Origin)

Objective： Infra-pyloric artery （IPA） is an important anatomical landmark in treatment of gastric cancer and is the key vessel for pylorus-preserving gastrectomy and subgroup of infra-pyloric lymph nodes. However, its anatomical variation is not thoroughly understood. Our study aimed to clarify the origination of the IPA. Methods： We did this prospective, multicenter, open-label, observational study at gastric surgery departments of 34 hospitals in China. Gastric cancer patients aged 18 years or older and scheduled to undergo elective total or distal gastrectomy were assigned. During the surgery, IPA dissecting and exposing the origination point with photographs or video clips were required. The primary outcome was the origination of the IPA. Analysis of variance, χ2 tests and Fisher＇s tests were used to analyze the differences between groups. The study is registered at Clinicaltrials.gov （No. NCT03071237）. Results： Between May 8 and July 31, 2017, 429 patients were assigned for the study, and 419 （97.7%） patients had the IPA dissected and recorded through photograph or video and were included in the primary outcome analysis. The median age was 62 years old, and 73.7% were male. Among the patients, 78.5% received laparoscopic surgery. Single IPA origination was identified in 398 （95.0%） patients, including gastroduodenal artery （GDA） in 154 （36.8%） patients, anterior superior pancreaticoduodenal artery （ASPDA） in 130 （31.0%） patients, and right gastroepiploic artery （RGEA） in 114 （27.2%） patients. Fifteen （3.6%） patients were identified with multiple IPA and 6 （1.4%） patients were identified as IPA absence. The differences in the distribution of surgical approach （P=0.003） and geographic area （P=0.030） were statistically significant. No difference was shown in sex, age, gastrectomy type, tumor location, and clinical T, N and M stage. Conclusions： Our study found that the IPA originates from GDA, ASPDA and RGEA in similar proportions. Laparoscopic surgery may be more helpful in dissection of the IPA than open surgery.

A novel approach for fabricating a CNT/AlSi composite with the self-aligned nacre-like architecture by cold spraying

A fully dense carbon nanotubes (CNTs) reinforced AlSi matrix composite with the multiscale nacre-like architecture was designed and successfully realized by flake powder metallurgy followed by cold spraying (CS). The nanolaminated and ultrafine-grained structure initially created in the CNT/AlSi flaky powder was perfectly conserved, due to the typical ‘cold’ feature of CS. As discussed based on finite element analysis and single splat observation, self-alignment behavior of the flaky powders during impact also allowed the formation of the microlaminated structure. Hence, the scalable CS technique opens a new avenue for bioinspired material design and fabrication with complex shape.

Association of systemic inflammation and body mass index with survival in patients with resectable gastric or gastroesophageal junction adenocarcinomas

Objective:The systemic inflammation index and body mass index(BMI)are easily accessible markers that can predict mortality.However,the prognostic value of the combined use of these two markers remains unclear.The goal of this study was therefore to evaluate the association of these markers with outcomes based on a large cohort of patients with gastric cancer.Methods:A total of 2,542 consecutive patients undergoing radical surgery for gastric or gastroesophageal junction adenocarcinoma between 2009 and 2014 were included.Systemic inflammation was quantified by the preoperative neutrophil-to-lymphocyte ratio(NLR).High systemic inflammation was defined as NLR≥3,and underweight was defined as BMI<18.5 kg/m2.Results:Among 2,542 patients,NLR≥3 and underweight were common[627(25%)and 349(14%),respectively].In the entire cohort,NLR≥3 or underweight independently predicted overall survival(OS)[hazard ratio(HR):1.236,95%confidence interval(95%CI):1.069–1.430;and HR:1.600,95%CI:1.350–1.897,respectively]and recurrence-free survival(RFS)(HR:1.230,95%CI:1.054–1.434;and HR:1.658,95%CI:1.389–1.979,respectively).Patients with both NLR≥3 and underweight(vs.neither)had much worse OS(HR:2.445,95%CI:1.853–3.225)and RFS(HR:2.405,95%CI:1.802–3.209).Furthermore,we observed similar results in subgroup analyses according to pathological stage,age,and postoperative chemotherapy.Conclusions:Our results showed that preoperative elevated NLR and decreased BMI had a significant negative effect on survival.Underweight combined with severe inflammation could enhance prognostication.Taking active therapeutic measures to reduce inflammation and increase nutrition may help improve outcomes.

Spin Injection from Ferromagnetic Semiconductor CoZnO into ZnO

2x （FeNi/CoZnO）/ZnO/（CoZnO/Co） x2 spin-inJection devices were prepared by sputtering and photo-lithography. In the devices, two composite magnetic layers 2x（FeNi/CoZnO） and （CoZnO/Co）x2 with different coercivities were used to fabricate the ZnO-based semiconductor spin valve. Since the CoZnO ferromagnetic semiconductor layers touched the ZnO space layer directly, the significant spin injection from CoZnO into ZnO was observed by measuring the magnetoresistance of the spin-injection devices. The magnetoresistance reduced linearly with increasing temperature, from 1.12% at 90 K to 0.35% at room temperature.

Relevance of MICA Alleles Matching Rate and Posttransplant Rejection in Clinical LRD Organ Transplantations

Objective: Recipients usually undergo posttransplant rejection in HLA-identical transplantations. Recent studies have shown that MHC class I related chain A (MICA) has been found to be associated with allograft survival. The goal of this study is to investigate the correlation between matching rate of MICA alleles and posttransplant rejection in clinical living related donor transplantation (LRD) organ transplantations. Methods: Twenty pairs of blood samples were detected for HLA/MICA matching through polymerase chain reaction with sequence specific primers and for anti-MICA Abs using Luminex. At the same time, pathologic biopsies of all recipients were diagnosed and classified into different levels by the unified standard. Univariate Spearman’s analysis was established. Log-Rank analysis was performed twice, and Kaplan-Meier survival curves were generated to assess the relationship between MICA matching rates and posttransplant rejection in living-related donor transplantations. Results-The result showed that HLA matching of all recipients and donors were identical, whereas MICA matching was not. There was statistical difference between pathological classification and survival

Current spin polarization and spin injection efficiency in ZnO-based ferromagnetic semiconductor junctions

[FeNi（3 nm）/Zn1-xCoxO（3 nm）]2/ZnO（d nm）/[Zn1-xCoxO（3 nm）/Co（3 nm）]2 （d=3 and 10） semiconductor junctions were prepared by magnetron sputtering system and photolithography. The spin valve effect was observed in these junctions because the utility of the ferromagnetic composite layers acted as soft and hard magnetic layers. The electrical detection was performed by measuring the magnetoresistance of these junctions to investigate the current spin polarization asc in the ZnO layer and the spin injection efficiency η of spin-polarized electrons. asc was reduced from 11.7% （and 10.5%） at 90 K to 7.31% （and 5.93%） at room temperature for d=3 （and d=10）. And η was reduced from 39.5% （and 35.5%） at 90 K to 24.7% （and 20.0%） at room temperature for d=3 （and d=10）.

Combining methylated SEPTIN9 and RNF180 plasma markers for diagnosis and early detection of gastric cancer

Dear Editor,Early diagnosis is critical for successful treatment of gastric adenocarcinoma(GA).However,the sensitivities of tumor markers carcinoembryonic antigen(CEA),cancer antigen 19-9(CA19-9)and CA72-4 for GA detection are approximately 20%[1],and the sensitivities of all markers combined for early gastric cancer detection is still very low[2].DNA methylation plays a major role in tumorigenesis and therefore has obvious potential as a non-invasive biomarker for cancer detection[3].Through genome-wide methylation analysis and histological verification,we previously identified ring finger protein 180(RNF180)as a novel preferentially methylated gene in GA[4,5].

Al matrix composites fabricated by solid-state cold spray deposition:A critical review

Cold spraying(CS),or cold gas dynamic spray(CGDS),is an emerging solid-state powder deposition process,allowing fast and mass production and restoration of metallic components.CS of metal matrix composites(MMCs)has attracted increasing attention from academia and industry over the last decades,especially in the area of Al matrix composites(AMCs),which have demonstrated a high potential for applications in aerospace,automotive,and electronics industries.This article aims to summarize the recent development of CS-processed AMCs in terms of composite powder preparation,deposition processing,microstructure evolution,mechanical and corrosion properties.Furthermore,this review also reports the relevant research progress with the focus on post-treatments of the AMCs for CS additive manufacturing applications including heat treatment,hot rolling,and friction stir processing.Finally,the challenges and perspectives on the fabrication of advanced AMCs by CS are addressed.

Beclin-1- mediated autophagy may be involved in the elderly cognitive and affective disorders in streptozotocininduced diabetic mice

Background:Diabetes is the most common metabolic disease with many chronic complications,and cognitive disorders are one of the common complications in patients with diabetes.Previous studies have showed that autophagy played important roles in the progression of metabolic syndrome,diabetes and other diseases.So we investigated whether aged diabetic mice are prone to be associated with the cognitive and affective disorders and whether Beclin-1-mediated autophagy might be involved in thepahological process.Methods:High-fat diet/streptozotocin(STZ)injection-induced diabetic C57 mice were adopted in this study.Cognitive disorders were detected by Morris water maze and fear conditional test.Affective disorders were detected by tail suspension test and forced swimming test.Magnetic resonance imaging was applied to observe changes of morphology and metabolism in the brain.The 18 F-fluorodeoxyglucose positron emission tomography(FDG-PET)was used to assess metabolism changes in the brain of aged diabetic mice.Autophagy were evaluated by Beclin-1,LC3II/I and P62,which were detected by western blot analysis and observed by electron microscopy.Results:1.Compared with control group,diabetes mice showed significantly decreasing abilities in spatial memory and conditioned fear memory(all P<0.05),and increasing tendency of depression(P<0.05).2.MRI showed that the majority of elderly diabetic mice were associated with multiple cerebral small vessel disease.Some even showed hippocampal atrophy,ventricular dilatation and leukoaraiosis.3.FDG-PET-CT discovered that the glucose metabolism in the amygdala and hippocampus was significantly decreased compared with normal aged mice(P<0.05).4.Electron microscopy found that,although autophagy bodies was not widespread,and there was no significant difference between the two groups,yet compared with normal aged mice,apparent cell edema,myelinated tow reduction and intracellular lipofuscin augmentation existed in elderly diabetic mice brain.5.The level of p62 was increased in the STZ-induced diabetic mice hippocampus and striatum,and beclin1 protein expression were significantly decreased in diabetic mice hippocampus compared with normal aged mice(P<0.05).There was a upward trend of the ratio of LC3II/I in hippocampus,cortex and striatum,but no statistically difference between the two groups.Conclusion:Compared with normal aged mice,diabetic aged mice were apt to cerebral small vessel disease and associated with cognitive and affective disorders,which may be related to the significantly reduced glucose metabolism in hippocampus and amygdala.Beclin1 mediated autophagy in hippocampus probably played an important role in cognitive and affective disorders of STZ-induced aged diabetic mice.

Proteomics provides individualized options of precision medicine for patients with gastric cancer

While precision medicine driven by genome sequencing has revolutionized cancer care,such as lung cancer,its impact on gastric cancer(GC)has been minimal.GC patients are routinely treated with chemotherapy,but only a fraction of them receive the clinical benefit.There is an urgent need to develop biomarkers or algorithms to select chemo-sensitive patients or apply targeted therapy.Here,we carried out retrospective analyses of 1,020 formalin-fixed,paraffin-embedded GC surgical resection samples from 5 hospitals and developed a mass spectrometry-based workflow for proteomic subtyping of GC.We identified two proteomic subtypes:the chemo-sensitive group(CSG)and the chemo-insensitive group(CIG)in the discovery set.The 5-year overall survival of CSG was significantly improved in patients who had received adjuvant chemotherapy after surgery compared with those who received surgery only(64.2%vs.49.6%;Cox P-value=0.002),whereas no such improvement was observed in CIG(50.0%vs.58.6%;Cox P-value=0.495).We validated these results in an independent validation set.Further,differential proteome analysis uncovered 9 FDA-approved drugs that may be applicable for targeted therapy of GC.A prospective study is warranted to test these findings for future GC patient care.

加速康复外科在我国胃肠外科应用现况的认知和态度调查

目的了解胃肠外科医生、护士和营养师对于加速康复外科(ERAS)“核心措施”在我国综合性医院的认知和态度以及临床应用现状。方法采用横断面调查研究的方法。于2021年9—10月开展问卷调查。调查对象为我国范围内开展胃肠外科的综合性医院、从事临床一线胃肠外科3年以上的医生和护士以及参与和指导胃肠外科治疗的营养师。排除实习、轮转及进修的医护人员或填写未达到质控标准的问卷。使用“问卷星”平台设计关于ERAS五项核心措施(术前营养、术中微创、术后活动、术后进食水及镇痛管理)的了解、认同和应用情况。通过微信向调查对象发送问卷链接。每项措施执行率超过60%,定义为“较好执行率”。结果共计发出问卷783份,共纳入全国56家综合性医院,质控后625份为有效问卷,占比79.82%。其中对ERAS五项核心措施的知晓率和认同率高达90.98%和91.14%,但是执行核心措施较好的比例低于46%,其中术中微创操作为46.72%、术后早期下床活动为46.24%、围术期镇痛管理为37.76%、术后早期进食水为25.76%、术前营养评估与营养支持为19.04%。影响措施执行的主要因素有:不熟悉术前营养筛查工具和技术(342/625,54.72%),医生担心围手术期镇痛副作用太大(466/625,74.56%),因患者病情不耐受腹腔镜手术(497/625,79.52%),早期进食水担心肠道不耐受(414/625,66.24%),早期下床活动时患者疼痛严重(442/625,70.72%)。结论我国部分综合性医院对于ERAS临床应用了解和认同率比较高,但是五项核心措施临床执行率较低,呈现严重分离状态。需要进一步开展临床研究,提高ERAS各项措施的证据级别,有利于信服一线医护人员。医院管理系统提高制度建设,有助于促进多学科合作,有利于ERAS措施的落实。

Ultra-structural study of insulin granules in pancreaticβ-cells of db/db mouse by scanning transmission electron microscopy tomography

Insulin granule trafficking is a key step in the secretion of glucose-stimulated insulin from pancreaticβ-cells.The main feature of type 2 diabetes(T2D)is the failure of pancreaticβ-cells to secrete sufficient amounts of insulin to maintain normal blood glucose levels.In this work,we developed and applied tomography based on scanning transmission electron microscopy(STEM)to image intact insulin granules in theβ-cells of mouse pancreatic islets.Using three-dimensional(3D)recon-struction,we found decreases in both the number and the grey level of insulin granules in db/db mouse pan-creaticβ-cells.Moreover,insulin granules were closer to the plasma membrane in diabeticβ-cells than in control cells.Thus,3D ultra-structural tomography may provide new insights into the pathology of insulin se-cretion in T2D.

Novel long laminar plasma sprayed hybrid structure thermal barrier coatings for high-temperature anti-sintering and volcanic ash corrosion resistance

1.Introduction The artificial-designed segmentation cracks in the ceramic layer of the thermal barrier coatings is an excellent choice by using the atmospheric plasma spray(APS)method under a low cost on the applications of aircraft engines or gas turbine engines.The residual thermal stress energy of the coatings with a certain inter-space of vertical cracks during the thermal cycling test is released through the cracks.

胃癌根治术后患者对于实施加速康复外科策略过程中的体验分析

目的探讨胃癌根治术后患者在加速康复外科(ERAS)策略执行中的体验以及影响治疗体验的因素。方法本研究采用前瞻性队列研究的方法,连续纳入2019年12月至2020年12月期间在空军军医大学第一附属医院(西京消化病医院)收治的经病理确诊为胃癌并接受胃癌根治术的患者;排除急诊手术、残胃癌、术前接受新辅助化疗和术中肿瘤不可根治切除或发现腹腔转移以及合并其他恶性肿瘤者。通过发放问卷的方式,调查患者对ERAS策略的期待和治疗期间的体验。患者对期待和体验方面的调查问题进行评分,0分表示完全不期待或不满意,10分表示很期待或十分满意。根据患者对于ERAS的不同体验,将患者根据出院时填写问卷中的“是否认可ERAS策略”项目分为ERAS认可组和抵触组。观察指标:(1)入组患者情况;(2)了解全组并比较两组患者对于ERAS的期望、偏好和住院体验;(3)两组促进和阻碍ERAS认可因素的比较;(4)了解全组并比较两组患者出院后的转归,采用电话方式进行随访,随访内容为术后30 d内并发症和身体是否不适,并发症按照Clavien-Dindo分类标准进行程度分级。正态分布的计量资料组间比较采用Student t检验。偏态分布的计量资料使用M(Q1,Q3)表示,组间比较采用独立样本的Mann-Whitney U检验。自身前后对照的正态分布与偏态分布资料分别采用配对Student t检验或Wilcoxon配对秩和检验。计数资料组间比较使用χ^(2)检验。结果纳入符合条件的患者112例,男88例,女24例;年龄(57.8±10.0)岁;其中ERAS认可组77例、抵触组35例。住院时,胃癌根治术患者普遍存在焦虑情绪,56.2%(63/112)患者的住院焦虑评分超过了8分。住院时患者对ERAS策略的了解程度不高[2(0,5)分],通过住院宣教,这一状况较前明显改善[8(4,10)分],差异有统计学意义(Z=-7.130,P<0.001)。患者预期的术后住院时间要长于实际住院时间[7(7,10)d比6(6,7)d],差异有统计学意义(Z=-4.800,P<0.001)。51.8%(58/112)的患者希望能够出院后直接返回家中继续康复,但32.1%(36/112)的患者更希望能够在医院继续治疗直到自己感觉身体完全康复。与ERAS抵触组相比,认可组患者的预期住院时间更短[7(6,10)d比10(7,15)d,Z=-2.607,P=0.009],康复效率提高评分更高[9(8,10)分比7(5,9)分,Z=-3.078,P=0.002],期望缓解疼痛[8(6,10)分比6(5,9)分,Z=-1.996,P=0.046]、体力恢复加速[8(6,10)分比6(4,9)分,Z=-2.200,P=0.028]、期待减少引流管[8(8,10)分比8(5,10)分,Z=-2.075,P=0.038]的评分均更高,差异均有统计学意义(均P<0.05)。在随访过程中,有105例患者接听了随访电话。57.1%(60/105)的患者在出院后经历了各种不适,其中包括疼痛(28.6%)、腹胀(20.0%)、恶心(12.4%)、疲乏(7.6%)和发热(2.9%)。出院30 d内,6.7%(7/105)的患者发生了Clavien-DindoⅠ、Ⅱ级手术相关并发症,包括伤口愈合不良、肠梗阻、腹腔出血、伤口感染,均经保守治疗治愈;全组术后未发生Ⅲ级以上并发症。与认可组相比,抵触组中更多的患者在出院时认为自己尚未达到自我预期的康复[22.9%(8/35)比57.1%(44/77),χ^(2)=11.372,P<0.001],且并不急于回归日常生活[8.6%(3/35)比39.0%(30/77),χ^(2)=10.693,P<0.001],差异均有统计学意义(均P<0.05)。仅52.4%(55/105)的患者返回家中进行后续康复,其余患者在出院后选择前往其他医院继续住院,再次住院时间的中位数为7(7,9)d。与ERAS抵触组比较,ERAS认可组居家康复比例更高[59.7%(12/33)比36.4%(43/72),χ^(2)=4.950,P=0.026]、自我认为术后完全康复时间更短[14(10,20)d比15(14,20)d,Z=2.100,P=0.036],差异均有统计学意义(均P<0.05)。结论尽管ERAS在保证手术安全的前提下促进了术后的康复,但尚未得到患者的一致认可。充分的康复宣教、良好的镇痛、较好的体力恢复以及引流管的早期去除,可能改善患者对于ERAS的体验。

Precipitation strengthening of nano-scale TiC in a duplex low-density steel under near-rapid solidification

Precipitation strengthening of nano-scale TiC is a promising method to improve mechanical properties of Fe–16Mn–9Al–0.8C (wt.%) low-density steel. This work attempted to introduce nano-scale TiC precipitates by adding 1 wt.% Ti element. The experimental results show that these precipitates with the total fraction of about 2 vol.% were formed and no coarse precipitates were observed despite the high Ti addition. It was interesting that the polygonal and needle-shaped TiC precipitates were observed in γ-austenite and δ-ferrite, respectively. Ti addition also decreased the volume fraction of γ-austenite significantly. Correspondingly, the yield strength was increased, but the elongation was significantly decreased due to the significant decrease of γ-austenite. Comparing with the Ti-free steel, the formation of TiC precipitates was the main reason for the increase in yield strength of Ti-bearing steel, and TiC precipitates also led to a higher strain hardening index at the first deformation stage. TiC precipitates promoted the Orowan strengthening, resulting in a higher strain hardening capability than Ti-free steel reinforced by shearable κ-carbide.

Laparoscopic gastrectomy for elderly gastric-cancer patients:comparisons with laparoscopic gastrectomy in non-elderly patients and open gastrectomy in the elderly

Background:The benefits of laparoscopic gastrectomy(LG)in elderly gastric-cancer patients still remain unclear.The purpose of this study was to evaluate the feasibility and safety of LG in elderly gastric-cancer patients.Methods:We retrospectively evaluated patients who underwent LG or open gastrectomy(OG)between June 2009 and July 2015 in a single high-volume center.We compared surgical,short-term,and long-termsurvival outcomes among an elderly(-70 years old)LG(ELG)group(n=114),a non-elderly(<70 years old)LG(NLG)group(n=740),and an elderly OG(EOG)group(n=383).Results:Except for extended time to first flatus,the surgical and short-term outcomes of the ELG group were similar to those of the NLG group.The ELG group revealed comparable disease-specific survival(DSS)rates to the NLG group(64.9%vs 66.2%,P=0.476),although the overall survival(OS)rate was lower(57.0%vs 65.5%,P<0.001)in the ELG group than in the NLG group.The ELG group showed longer operation time than the EOG group(236.4677.3 vs 179652.2 min,P<0.001).The ELG group had less estimated blood loss(174.0688.4 vs 209.36133.8,P=0.008)and shorter post-operative hospital stay(8.362.5 vs 9.264.5,P=0.048)than the EOG group.The severity of complications was similar between the ELG and NLG groups.Multivariate analysis confirmed that LG was not a risk factor for post-operative complications.Conclusions:LG is a feasible and safe procedure for elderly patients with acceptable short-and long-term survival outcomes.