Exploring ideal operative time for best outcomes in gastric cancer surgery:A multi-institutional study based on KLASS-07 database

Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery.Methods:A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed.The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries.Finally,intraoperative and postoperative outcomes were compared among the shorter,ideal,and longer operative time groups.Results:The statistically calculated ideal operative time was 135.4-165.4 min.The longer operative time(LOT)group had a lower rate of uneventful,perfect surgery than the ideal or shorter operative time(IOT/SOT)group(2.8%vs.8.8%and 2.2%vs.13.4%,all P<0.05).Longer operative time increased bleeding,postoperative morbidities,and delayed diet and discharge(all P<0.05).Particularly,an uneventful,perfect surgery could not be achieved when the operative time exceeded 240 min.Regardless of ideal time range,SOT group achieved the highest percentage of uneventful surgery(13.4%),which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform≥150 gastrectomies annually.Conclusions:Operative time longer than the ideal time range(especially≥240 min)should be avoided.If the essential operative procedure were faithfully conducted without compromising oncological safety,an operative time shorter than the ideal range leaded to a better prognosis.Efforts to minimize operative time should be attempted with sufficient surgical experience.

Artificial photosynthesis for high-value-added chemicals:Old material,new opportunity

Solar energy utilization has drawn attention due to ever-increasing environmental and energy issues.Photoelectrochemical(PEC)and photocatalytic(PC)water splitting for hydrogen production,which is the most popular and well-established solar-to-chemical conversion process,has been studied thoroughly to date but is now facing limitations related to low conversion efficiency.To resolve this issue,research in PEC cells or photocatalysts has recently aimed to produce alternative value-added chemicals by modifying their redox reactions,which potentially enables high economic reward to compensate for the low efficiency.Here,various kinds of redox reactions that decouple classic water splitting reactions to produce value-added chemicals via PEC and PC processes are introduced.Successful coupling of CO_(2) reduction,O_(2) reduction and organic synthesis with either water oxidation or water reduction is comprehensively discussed from the perspective of basic fundamental and product selectivity in terms of the band structure of materials,cocatalyst design,and thermodynamics and kinetics of the reactions.Throughout the review,future challenges and opportunities are suggested with respect to the redesigned artificial synthesis,which might be an alternative development for the commercialization of PEC or PC value-added chemical production technologies in the near future.

Neuroendocrine carcinoma of the stomach:A case report

Neuroendocrine carcinoma(NEC)is a rare tumor,comprising【1%of stomach cancers.A 55-year-old woman was referred to our hospital with biopsy-proven gastric cancer.A shallow ulcerative lesion was detected in the lesser curvature of the lower body.It was suspected to be early gastric cancerⅡA+ⅡC type.Thus,endoscopic submucosal dissection was performed.She was subsequently diagnosed with NEC,which is aggressive and carries a poor prognosis.We conducted a radical resection and a laparoscopic-assisted distal gastrectomy.The tumor had infiltrated the subserosal layer and6/42 lymph nodes were involved.The mitotic index was16/10 high power fields and the Ki-67 labeling index was 26%-50%.The final diagnosis of NEC was made according to the World health Organization 2010 criteria.She was suspected of having jumping metastasis to the proximal margin.The patient was treated with an oral anticancer drug(5-flurouracil based drug)for2 years.The patient has been followed up for 3 years without recurrence.

Recurrence of gastric cancer in the jejunal stump after radical total gastrectomy

This is a very rare case of the recurrence of gastric cancer in the jejunal stump after radical total gastrectomy with Roux-en-Y reconstruction.In January 2008,a 65-year-old man underwent radical total gastrectomy with Roux-en-Y reconstruction for stageⅠB gastric cancer of the upper body.At a follow-up in December2011,the patient had a recurrence of gastric cancer on gastroduodenal fibroscopy.The gastroduodenal fibroscopic biopsy specimens show a well-differentiated tubular adenocarcinoma.Computed tomography showed no lymphadenopathy or hepatic metastases.At laparotomy,there was a tumor in the jejunal stump involving the pancreatic tail and spleen.Therefore,the patient underwent jejunal pouch resection,distal pancreatectomy and splenectomy.The patient was diagnosed with gastric cancer on histopathological examination.

Reporting Corporate Social Responsibility： Using Comparative Messages to Influence Attitudes and Purchase Intentions

This study examined whether exposure to a firm＇s report of corporate social responsibility （CSR） activities affected attitudes toward the firm and increased behavioral intent to purchase products and services from it. Findings showed that increased knowledge of a company＇s CSR deeds fosters positive attitudes and favorable purchase intentions toward the company. Reports that compared the firm＇s CSR activities to the competitor＇s activities favorably affected consumers＇ attitudes and purchase intentions positively. On the other hand, self-promotional reports affected neither attitudes nor purchase intentions significantly.