Impact of baseline steroids on the efficacy of neoadjuvant immunochemotherapy in locally advanced esophageal squamous cell carcinoma

BACKGROUND Immunochemotherapy involving the combination of programmed cell death 1/programmed cell death ligand 1 inhibitors with chemotherapy has advanced the treatment of locally advanced esophageal squamous cell carcinoma(ESCC).The use of corticosteroids as pretreatment might reduce immunotherapy efficacy.AIM To investigate the impact of baseline corticosteroid use on neoadjuvant immunochemotherapy(nIC)outcomes in locally advanced ESCC patients.METHODS Patients with locally advanced ESCC who received nIC at Sun Yat-sen University Cancer Center and the Third Affiliated Hospital of Sun Yat-sen University were included.Patients were divided into dexamethasone and antihistamine groups on the basis of the administered pretreatment.Antiallergic efficacy and safety were evaluated,as well as its impact on short-term efficacy[complete pathological response(pCR),major pathological response(MPR)]and long-term efficacy[overall survival(OS),progression-free survival(PFS)]of nIC.RESULTS From September 2019 to September 2023,142 patients were analyzed.No severe treatment-related adverse events or deaths were observed.Allergy occurrence was greater in the antihistamine group(P=0.014).Short-term efficacy was not significantly different:The pCR rates were 29.9%and 40.0%,and the MPR rates were 57.9%and 65.7%in the dexamethasone and antihistamine groups,respectively.The long-term efficacy was not significantly different:The 2 years OS rates were 95.2%and 93.5%,and the 2 years PFS rates were 90.3%and 87.8%.Subgroup analysis revealed no difference in OS between the 20 mg dexamethasone group and the<20 mg dexamethasone group,but PFS was significantly greater in the 20 mg dexamethasone group(93.9%vs 56.4%,P=0.001).CONCLUSION Dexamethasone or antihistamines can be used before nIC in locally advanced ESCC without affecting short-or long-term efficacy.Administering 20 mg dexamethasone before nIC may improve PFS in ESCC.

Evaluating effectiveness and safety of combined percutaneous transhepatic gallbladder drainage and laparoscopic cholecystectomy in acute cholecystitis patients:Meta-analysis

BACKGROUND Acute cholecystitis(AC)is a common disease in general surgery.Laparoscopic cholecystectomy(LC)is widely recognized as the"gold standard"surgical procedure for treating AC.For low-risk patients without complications,LC is the recommended treatment plan,but there is still controversy regarding the treatment strategy for moderate AC patients,which relies more on the surgeon's experience and the medical platform of the visiting unit.Percutaneous transhepatic gallbladder puncture drainage(PTGBD)can effectively alleviate gallbladder inflammation,reduce gallbladder wall edema and adhesion around the gallbladder,and create a"time window"for elective surgery.AIM To compare the clinical efficacy and safety of LC or PTGBD combined with LC for treating AC patients,providing a theoretical basis for choosing reasonable surgical methods for AC patients.METHODS In this study,we conducted a clinical investigation regarding the combined use of PTGBD tubes for the treatment of gastric cancer patients with AC.We performed searches in the following databases:PubMed,Web of Science,EMBASE,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Database.The search encompassed literature published from the inception of these databases to the present.Subsequently,relevant data were extracted,and a meta-analysis was conducted using RevMan 5.3 software.RESULTS A comprehensive analysis was conducted,encompassing 24 studies involving a total of 2564 patients.These patients were categorized into two groups:1371 in the LC group and 1193 in the PTGBD+LC group.The outcomes of the meta-analysis revealed noteworthy disparities between the PTGBD+LC group and the LC group in multiple dimensions:(1)Operative time:Mean difference(MD)=17.51,95%CI:9.53-25.49,P<0.01;(2)Conversion to open surgery rate:Odds ratio(OR)=2.95,95%CI:1.90-4.58,P<0.01;(3)Intraoperative bleeding loss:MD=32.27,95%CI:23.03-41.50,P<0.01;(4)Postoperative hospital stay:MD=1.44,95%CI:0.14-2.73,P=0.03;(5)Overall postoperative compli-cation rate:OR=1.88,95%CI:1.45-2.43,P<0.01;(6)Bile duct injury:OR=2.17,95%CI:1.30-3.64,P=0.003;(7)Intra-abdominal hemorrhage:OR=2.45,95%CI:1.06-5.64,P=0.004;and(8)Wound infection:OR=0.These find-ings consistently favored the PTGBD+LC group over the LC group.There were no significant differences in the total duration of hospitalization[MD=-1.85,95%CI:-4.86-1.16,P=0.23]or bile leakage[OR=1.33,95%CI:0.81-2.18,P=0.26]between the two groups.CONCLUSION The combination of PTGBD tubes with LC for AC treatment demonstrated superior clinical efficacy and enhanced safety,suggesting its broader application value in clinical practice.

A randomized controlled trial of group mindfulness therapy on sleep quality of the elderly in nursing homes

Background:Poor sleep quality of the elderly in nursing homes will reduce the quality of life,which needs to be treated properly.The purpose of the study is to investigate the effect of group mindfulness therapy on sleep quality of the elderly in nursing homes.Methods:A parallel randomized controlled trial was used in this study.The semi-structure interview and the mindfulness therapy intervention was used as the intervention.The Pittsburgh sleep quality index scale and Glaizzi phenoenological data for a 7-step was used to analyze the results.Results:After 8 weeks of intervention,the sleep quality of elderly people was improved to a certain extent(P<0.05).Our investigation showed that some elderly people think that through this kind of training they had reduced the frequency of taking sleeping pills.Conclusion:Group mindfulness therapy could improve sleep quality to some extent.

Characteristics of secondary electron emission from few layer graphene on silicon(111) surface

As a typical two-dimensional(2D) coating material, graphene has been utilized to effectively reduce secondary electron emission from the surface. Nevertheless, the microscopic mechanism and the dominant factor of secondary electron emission suppression remain controversial. Since traditional models rely on the data of experimental bulk properties which are scarcely appropriate to the 2D coating situation, this paper presents the first-principles-based numerical calculations of the electron interaction and emission process for monolayer and multilayer graphene on silicon(111) substrate. By using the anisotropic energy loss for the coating graphene, the electron transport process can be described more realistically. The real physical electron interactions, including the elastic scattering of electron-nucleus, inelastic scattering of the electron-extranuclear electron, and electron-phonon effect, are considered and calculated by using the Monte Carlo method. The energy level transition theory-based first-principles method and the full Penn algorithm are used to calculate the energy loss function during the inelastic scattering. Variations of the energy loss function and interface electron density differences for 1 to 4 layer graphene coating Go Si are calculated, and their inner electron distributions and secondary electron emissions are analyzed. Simulation results demonstrate that the dominant factor of the inhibiting of secondary electron yield(SEY) of Go Si is to induce the deeper electrons in the internal scattering process. In contrast, a low surface potential barrier due to the positive deviation of electron density difference at monolayer Go Si interface in turn weakens the suppression of secondary electron emission of the graphene layer. Only when the graphene layer number is 3, does the contribution of surface work function to the secondary electron emission suppression appear to be slightly positive.

Combining surgery with 125I brachytherapy for recurrent mediastinal dedifferentiated liposarcoma: A case report and review of literature

BACKGROUND Dedifferentiated liposarcoma in the mediastinum is an extremely rare malignant neoplasm.A few previous case reports indicate that surgical resection is the major treatment,but frequent recurrence occurs locally.Due to its rarity,its clinical characteristics,optimal treatment and clinical outcomes remain unclear.Here,we report a case of multifocal recurrent dedifferentiated liposarcoma in the posterior mediastinum treated by combining surgery with 125I brachytherapy,and summarize its clinical features,treatment and prognosis.CASE SUMMARY A 75-year-old man was admitted to our hospital with a history of gradual dysphagia for one year and aggravated dysphagia for 3 mo.Contrast-enhanced computed tomography(CT)revealed several large cystic-solid masses with lipomatous density,and calcification in the posterior-inferior mediastinum.The patient received a wide excision by video-assisted thoracoscopic surgery.Pathological analysis confirmed the tumors were dedifferentiated liposarcomas.The tumor locally relapsed 24 mo later,and another operation was performed by video-assisted thoracoscopic surgery.Fifteen months after the second surgery,the tumor recurred again,and the patient received CT-guided radioactive seeds 125I implantation.After 8 mo,follow-up chest CT showed an enlarged tumor.Finally,his condition exacerbated with severe dysphagia and dyspnea,and he died of respiratory failure in July 2018.CONCLUSION We reviewed the literature,and suggest that surgical resection provides beneficial effects for dedifferentiated liposarcoma in the mediastinum,even in cases with local recurrence.125I brachytherapy may be beneficial for recurrent unresectable patients.

Effect of Gongliuxiao Capsule on sex hormones, tumor markers, inflammatory factors and vascular endothelial function in patients with uterine fibroids

Objective:To investigate the effects of Gongliuxiao Capsule on inflammatory factors, tumor markers, sex hormones and vascular endothelial function in patients with uterine fibroids. Methods:130 patients with uterine fibroids admitted to our hospital from October 2015 to March 2017 were enrolled. According to the treatment, they were divided into single treatment group and combined medication group, with 65 cases in each group. The changes of inflammatory factors, tumor markers, sex hormones and vascular endothelial function were compared before and after treatment in the two groups.Results: There were no significant differences in the levels of sex hormones, inflammatory factors, tumor markers and vascular endothelial function between the two groups (P>0.05). The levels of sex hormones E2, P, FSH and LH, the levels of inflammatory factors TNF-α, MMP-9 and IGF-1, tumor markers CA125, CA19-9 and vascular endothelial function VEGF and b-FGF were significantly lower in the two groups (P<0.05). The levels of E2, P, FSH and LH in the combined drug groupswere (154.12±16.20) pmol/L, (9.12±1.02) μg/L, (13.84±1.42) U/L and (12.77±1.36) U/L, respectively,which were significantly lower than the single drug group level (P<0.05). The levels of CA125 and CA19-9 in the combined drug group were (27.89±2.88) U/mL and (28.09±3.04) U/mL, respectively, which were significantly lower than the single drug group (P<0.05). The levels of TNF-α, MMP-9 and IGF-1 in the combined drug group were (24.16±2.63) ng/L, (159.22±16.82) μg/L and (69.75±7.09) μg/L, respectively, which were significantly lower than the single drug group(P<0.05). The levels of VEGF and b-FGF in the combination group were (138.29±14.32) μg/L and (98.59±10.02) μg/L, respectively, which were significantly lower than the single drug group (P<0.05).Conclusion:Mifepristone combined with Gongliuxiao Capsule can alleviate endocrine disorders, relieve inflammatory stress response and improve vascular endothelial function in patients with uterine fibroids. It is worthy of clinical application.

The impact of mindfulness therapy on life happiness of the elderly in nursing homes

Background:Nursing homes have been developed as an important way to solve the old-age care problem.While,nursing homes in China pay attention to the life care of the elderly,but lack of promoting the life happiness of the elderly.Mindfulness therapy is an emerging approach to improve the individual's ability to regulate emotions and maintain the stability of emotions.Purpose:To explore the effect of mindfulness therapy on improving life happiness of elderly in nursing homes.Methods:The study was performed in 2019 in Tianjin,in China.Seventy-six participants eventually were included in the study to receive either daily life care or daily life care and mindfulness therapy.The treatment lasted for eight weeks.The Campbell Index of Well-being and Satisfaction With Life Scale were mainly adopted.The paired sample t-test was conducted for comparing between two groups,using SPSS 17.0.Results:Subjective well-being was shown to be a significant correlation with life satisfaction.Compared with before treatment,the well-being(9.57±3.00 vs 11.69±2.32)and life satisfaction scores(20.43±8.08 vs 26.70±5.61)were increased significantly in mindfulness therapy group(P<0.05).The means of the subjective well-being and life satisfaction scores in mindfulness therapy group were 11.69±2.32 and 26.70±5.61 after the intervention,respectively,whereas the means of the subjective well-being and life satisfaction scores in the control group were 10.27±2.16 and 23.03±5.59,respectively.A significant change was found between two groups(t=2.141,P<0.05;t=2.395,P<0.05).Conclusion:Mindfulness therapy may be an effective therapy to improve life happiness of elderly in nursing homes.

交通基础设施智能化研究进展

受最新材料科学、计算机技术、人工智能和自动控制技术的启发,新一代交通基础设施正在走向数字化和智能化。世界上许多主要发达国家都在因地制宜,积极推动智能创新技术在交通基础设施中的应用。本文首先简要介绍了交通基础设施智能化的基本概念、科学依据和发展历程。然后,按照设计、施工、运维、淘汰的全生命周期链条,系统分析了智能化技术的研究现状和面临的主要挑战。随后,以世界上第一条基于智能建设理念建设的铁路——北京-张家口高铁为例,全面介绍了智能技术的最新成就。最后,从标准体系、理论方法和人才培养三个维度对交通基础设施智能化的未来发展进行了探讨。

Gonadotropin-releasing hormone positively regulates steroidogenesis via extracellular signal-regulated kinase in rat Leydig cells

Gonadotropin-releasing hormone （GnRH） is secreted from neurons within the hypothalamus and is necessary for reproductive function in all vertebrates. GnRH is also found in organs outside of the brain and plays an important role in Leydig cell steroidogenesis in the testis. However, the signalling pathways mediating this function remain largely unknown. In this study, we investigated whether components of the mitogen-activated protein kinase （MAPK） pathways are involved in GnRH agonist （GnRHa）-induced testis steroidogenesis in rat Leydig cells. Primary cultures of rat Leydig cells were established. The expression of 3β-hydroxysteroid dehydrogenase （3β-HSD） and the production of testosterone in response to GnRHa were examined at different doses and for different durations by RT-PCR, Western blot analysis and radioimmunoassay （RIA）. The effects of GnRHa on ERK1/2, JNK and p38 kinase activation were also investigated in the presence or absence of the MAPK inhibitor PD-98059 by Western blot analysis. GnRHa induced testosterone production and upregulated 3β-HSD expression at both the mRNA and protein levels; it also activated ERK1/2, but not JNK and p38 kinase. Although the maximum effects of GnRHa were observed at a concentration of 100 nmnol L-1 after 24 h, activation of ERKI/2 by GnRHa reached peak at 5 min and it returned to the basal level within 60 min. PD-98059 completely blocked the activation of ERKI/2, the upregulation of 3β-HSD and testosterone production. Our data show that GnRH positively regulates steroidogenesis via ERK signalling in rat Leydig cells. ERK1/2 activation by GnRH may be responsible for the induction of 3β-HSDgene expression and enzyme production, which may ultimately modulate steroidogenesis in rat Leydig cells.

Bystander effect and abscopal effect in recurrent thymic carcinoma treated with carbon-ion radiation therapy:A case report

BACKGROUND Although the bystander effect and abscopal effect are familiar in medicine,they are relatively rare in clinical practice.Herein,we report the case of a patient who demonstrated an obvious bystander effect and abscopal effect response following carbon-ion irradiation for recurrent thymic carcinoma.CASE SUMMARY A 44-year-old female presented with shortness of breath.Eleven years prior,she was diagnosed with athymic tumor located in the anterosuperior mediastinum.She underwent extensive tumor resection,and the postoperative pathologic diagnosis was thymic carcinoma.She was administered 50 Gy/25 Fx of postoperative radiation.In 2019,she was diagnosed with a recurrence of thymic carcinoma,with multiple recurrent nodules and masses in the left thoracic chest and peritoneal cavity,the largest of which was in the diaphragm pleura proximal to the pericardium,with a size of 6.7 cm×5.3 cm×4.8 cm.She received carbonion radiotherapy.After carbon-ion radiotherapy treatment,the treated masses and the untreated masses were observed to have noticeably shrunk on the day of carbon-ion radiotherapy completion and on follow-up imaging.We followed the CARE Guidelines for consensus-based clinical case reporting guideline development and completed the CARE Checklist of information to report this case.CONCLUSION This report is the first of obvious abscopal and bystander effects following carbonion irradiation in a human patient,and further research is needed to better elucidate the mechanisms of bystander and abscopal effects.

Carbon ion radiotherapy for synchronous choroidal melanoma and lung cancer: A case report

BACKGROUND Despite being the most common intraocular malignancy among adults,choroidal melanoma is a rare cancer type,even more so when accompanied by lung cancer.We report a patient with synchronous choroid melanoma and lung cancer treated with carbon ion radiotherapy(CIRT).CASE SUMMARY A 41-year-old woman was transferred to our center with a diagnosis of choroidal melanoma in her right eye.During the examination,we found a right lung tumor that was histologically diagnosed as lung cancer.The patient was treated with CIRT for both malignant neoplasms.The CIRT dose was 70 photon equivalent doses(GyE)in five fractions for the right eye choroidal melanoma and 72 GyE in 16 fractions for the right lung cancer.At 3 mo after CIRT,the choroidal melanoma completely disappeared,as did the right lung cancer 7 mo after;the patient was in complete remission.CONCLUSION CIRT may be an effective treatment for double primary lung cancer and choroid melanoma.

Carbon ion radiotherapy for bladder cancer: A case report

BACKGROUND Radical cystectomy is considered the first choice for the treatment of muscleinvasive bladder cancer.However,for some patients who have lost the indications for surgery,external beam radiotherapy is a non-invasive and effective treatment.CASE SUMMARY A 76-year-old patient with bladder cancer who had serious comorbidities and could not tolerate surgery or chemotherapy came to the Wuwei Heavy Ion Center.He received carbon ion radiotherapy(CIRT)with a whole-bladder dose of 44 GyE and tumor boost of 20 GyE.When he finished CIRT,his bladder cancer-related hematuria completely disappeared,and computed tomography examination showed that the tumor had obviously decreased in size.At the 3-mo follow-up,the tumor disappeared,and there were no acute or late adverse events.CIRT was well tolerated in this patient.CONCLUSION CIRT may allow for avoiding resection and was well tolerated with curative outcomes.

Rupture directivity effect on strong ground motion during the 12 May 2008 M_(W)7.9 Wenchuan earthquake

We focus here on the rupture directivity effect on the spatial distribution and attenuation characteristics of near-field ground motions during the 2008 MW7.9 Wenchuan earthquake.We examine the difference between the observed ground motions in and opposite the rupture directions and compare them with Next Generation Attenuation-West2(NGA-West2)ground motion prediction models.The isochrone directivity predictor is used to quantify the band-limited nature of the rupture directivity effect on strong ground motion.Our results show that the observed peak ground velocity(PGV)and spectral accelerations of periods of 1.0 s and longer are significantly amplified in the rupture direction,but de-amplified in the opposite direction affected by rupture directivity effect of this event.In contrast,the effect of rupture directivity on the observed peak ground acceleration(PGA)and periods of shorter than 1.0 s are relatively weak.The rupture directivity of this event shows clear period dependent and band limited characteristics with the strongest effect occurring around the period of 7.5 s.

Cross-sectional survey following a longitudinal study on mental health and insomnia of people with sporadic COVID-19

BACKGROUNDIn the post-pandemic era, the emergence of sporadic cases of coronavirus disease 2019 (COVID-19) and the scale of the pandemic are unpredictable. Therefore, the impact ofsporadic cases of COVID-19 and isolation measures on mental health and sleep in different groupsof people need to be analyzed.AIMTo clarify the severity of psychological problems and insomnia of staff and community residentsaround a hospital with sporadic cases of COVID-19, and their relationship with quarantinelocation and long-term changes.METHODSA cross-sectional survey was conducted on community residents and medical staff. Many of thesemedical staff had been subjected to different places of quarantine. Community residents did notexperience quarantine. Hospital anxiety and depression scale (HADS), acute stress disorder scale(ASDS) and insomnia severity index (ISI) were used to evaluate anxiety and depression, acutestress disorder symptoms, and the severity of insomnia. Additionally, we conducted a 1-yearfollow-up study on medical staff, with related scales measurement immediately after and one yearafter the 2-wk quarantine period.RESULTSWe included 406 medical staff and 226 community residents. The total scores of ISI and subscale inHADS of community residents were significantly higher than that of medical staff. Furtheranalysis of medical staff who experienced quarantine showed that 134 were quarantined in hotels,70 in hospitals and 48 at home. Among all subjects, the proportions of HADS, ASDS and ISI scoresabove normal cutoff value were 51.94%, 19.17% and 31.11%, respectively. Multivariable logisticregression analysis found that subjects with higher total ASDS scores had a greater risk to developanxiety and depression. The total ISI score for medical staff in hotel quarantine was significantlyhigher than those in home quarantine. Total 199 doctors and nurses who completed the 1-yearfollow-up study. Compared with baseline, HADS and ASDS scores decreased significantly oneyear after the end of quarantine, while ISI scores did not change significantly.CONCLUSIONSporadic COVID-19 cases had a greater psychological impact on residents in surroundingcommunities, mainly manifested as insomnia and depressive symptoms. Hotel quarantineaggravated the severity of insomnia in medical staff, whose symptoms lasted ≥ 1 year.

Breakdown voltage enhancement in GaN channel and AlGaN channel HEMTs using large gate metal height

A large gate metal height technique is proposed to enhance breakdown voltage in GaN channel and AlGaN channel high-electron-mobility-transistors(HEMTs).For GaN channel HEMTs with gate-drain spacing LGD=2.5μm,the breakdown voltage VBR increases from 518 V to 582 V by increasing gate metal height h from 0.2μm to 0.4μm.For GaN channel HEMTs with LGD=7μm,VBR increases from 953 V to 1310 V by increasing h from 0.8μm to 1.6μm.The breakdown voltage enhancement results from the increase of the gate sidewall capacitance and depletion region extension.For Al0.4Ga0.6N channel HEMT with LGD=7μm,VBR increases from 1535 V to 1763 V by increasing h from 0.8μm to 1.6μm,resulting in a high average breakdown electric field of 2.51 MV/cm.Simulation and analysis indicate that the high gate metal height is an effective method to enhance breakdown voltage in GaN-based HEMTs,and this method can be utilized in all the lateral semiconductor devices.

KGSR-GG:A Noval Scheme for Dynamic Recommendation

Recommendation algorithms regard user-item interaction as a sequence to capture the user’s short-term preferences,but conventional algorithms cannot capture information of constantly-changing user interest in complex contexts.In these years,combining the knowledge graphwith sequential recommendation has gained momentum.The advantages of knowledge graph-based recommendation systems are that more semantic associations can improve the accuracy of recommendations,rich association facts can increase the diversity of recommendations,and complex relational paths can hence the interpretability of recommendations.But the information in the knowledge graph,such as entities and relations,often fails to be fully utilized and high-order connectivity is unattainable in graph modelling in knowledge graph-based sequential recommender systems.To address the above problems,a knowledge graph-based sequential recommendation algorithm that combines the gated recurrent unit and the graph neural network(KGSRGG)is proposed in the present work.Specifically,entity disambiguation in the knowledge graph is performed on the preprocessing layer;on the embedding layer,the TransR embedding technique is employed to process the user information,item information and the entities and relations in the knowledge graph;on the aggregation layer,the information is aggregated by graph convolutional neural networks and residual connections;and at last,on the sequence layer,a bi-directional gated recurrent unit(Bi-GRU)is utilized to model the user’s sequential preferences.The research results showed that this newalgorithm performed better than existing sequential recommendation algorithms on the MovieLens-1M and Book-Crossing datasets,as measured by five evaluation indicators.

Primary small cell esophageal carcinoma,chemotherapy sequential immunotherapy:A case report

BACKGROUND Primary small cell esophageal carcinoma(PSCEC)is aggressive and rare,with a worse prognosis than other subtypes esophageal carcinoma.No definitive and optimum standard guidelines are established for treating it.Herein,we report a case of PSCEC,including a current literature review of PSCEC.CASE SUMMARY A 79-year-old male was diagnosed PSCEC with multiple lymph node metastasis thorough computed tomography,positron emission tomography-computed tomography,endoscopy and pathology.Surgery was not suitable for this patient.He was treated with etoposide 100 mg/m2 and cisplatin 25 mg/m2 on days 1-3,every 3 wk for 4 cycles.The tumor and lymph nodes became smaller and dysphagia and vomiting symptoms improved.The patient could not tolerate subsequent chemotherapy(CT)because of hematological toxicity;therefore,we performed immunotherapy(durvalumab,1500 mg)every 4 wk.At present the patient has received 12 cycles immunotherapy over about 1 year.He is still receiving treatment and follow-up.CONCLUSION PSCEC with multiple lymph nodes metastasis does not always indicate surgery.CT may extend survival time and improve the quality of life in the absence of surgery.Immunotherapy or immunotherapy plus CT may also work as a treatment for PSCEC.

How to examine anastomotic integrity intraoperatively in totally laparoscopic radical gastrectomy? Methylene blue testing prevents technical defect-related anastomotic leaks

BACKGROUND Intraoperative methylene blue testing(IMBT),air leak testing,or endoscopy is used to assess the anastomotic integrity of esophagojejunostomy during open total gastrectomy for gastric cancer.Totally laparoscopic radical gastrectomy has been widely used to treat gastric cancer in the last few decades.However,reports on testing anastomotic integrity in totally laparoscopic radical gastrectomy are limited.AIM To explore the effects of IMBT on the incidence of postoperative anastomotic leaks(PALs)and identify the risk factors for PALs in totally laparoscopic radical gastrectomy.METHODS From January 2017 to December 2019,patients who underwent totally laparoscopic radical gastrectomy at the Shaanxi Provincial People's Hospital were retrospectively analyzed.According to whether or not they experienced an IMBT,the patients were divided into an IMBT group and a control group.If the IMBT was positive,an intraoperative suture was required to reinforce the anastomosis.The difference in the incidence of PALs was compared,and the risk factors were investigated.RESULTS This study consisted of 513 patients,211 in the IMBT group and 302 in the control group.Positive IMBT was shown in seven patients(3.3%)in the IMBT group,and no PAL occurred in these patients after suture reinforcement.Multivariate analysis showed that risk factors for predicting positive IMBT were body mass index(BMI)>25 kg/m2(hazard ratio[HR]=8.357,P=0.009),operation time>4 h(HR=55.881,P=0.002),and insufficient surgical experience(HR=15.286,P=0.010).Moreover,15 patients(2.9%)developed PALs in 513 patients,and the rates of PALs were significantly lower in the IMBT group than in the control group[2 of 211 patients(0.9%)vs 13 of 302 patients(4.3%),P=0.0026].Further analysis demonstrated that preoperative complications(HR=13.128,P=0.017),totally laparoscopic total gastrectomy(HR=9.075,P=0.043),and neoadjuvant chemotherapy(HR=7.150,P=0.008)were independent risk factors for PALs.CONCLUSION IMBT is an effective method to evaluate the integrity of anastomosis during totally laparoscopic radical gastrectomy,thus preventing technical defect-related anastomotic leaks.Preoperative complications,totally laparoscopic total gastrectomy,and neoadjuvant chemotherapy are independent risk factors for PALs.

Paying Attention to Special Populations:1 Case of COVID-19 Asymptomatic Infection with Positive Nucleic Acid and Negative Antibodies in Puerpera

As a newly emerged disease,COVID-19's in-depth understanding is still being explored.And also as the epidemic changes,various new situations will be encountered.Atypical patients have brought difficulties to our prevention and control of this disease.Among them,asymptomatic patients are a special category,and puerperae are a special population.What happens when a puerpera is infected with asymptomatic COVID-19?This study describes 1 case of COVID-19 asymptomatic infection with positive nucleic acid and negative antibodies in puerpera.The aim is to remind clinicians to take special cases seriously,such as puerperae and pregnant women,AIDS,and other immunocompromised patients.It may not be enough to rely solely on antibody detection,but more than two repeated nucleic acid tests are necessary,so that no suspicious patient can be easily let off.

Hybrid gelatin/oxidized chondroitin sulfate hydrogels incorporating bioactive glass nanoparticles with enhanced mechanical properties, mineralization, and osteogenic differentiation

Biopolymer based hydrogels are characteristic of their biocompatibility and capability of mimicking extracellular matrix structure to support cellular behavior.However,these hydrogels suffer from low mechanical properties,uncontrolled degradation,and insufficient osteogenic activity,which limits their applications in bone regeneration.In this study,we developed hybrid gelatin(Gel)/oxidized chondroitin sulfate(OCS)hydrogels that incorporated mesoporous bioactive glass nanoparticles(MBGNs)as bioactive fillers for bone regeneration.Gel-OCS hydrogels could be self-crosslinked in situ under physiological conditions in the presence of borax.The incorporation of MBGNs enhanced the crosslinking and accelerated the gelation.The gelation time decreased with increasing the concentration of MBGNs added.Incorporation of MBGNs in the hydrogels significantly improved the mechanical properties in terms of enhanced storage modulus and compressive strength.The injectability of the hydrogels was not significantly affected by the MBGN incorporation.Also,the proliferation and osteogenic differentiation of rat bone marrow mesenchymal stem cells in vitro and rat cranial defect restoration in vivo were significantly promoted by the hydrogels in the presence of MBGNs.The hybrid Gel-OCS/MBGN hydrogels show promising potential as injectable biomaterials or scaffolds for bone regeneration/repair applications given their tunable degradation and gelation behavior as well as favorable mechanical behavior and osteogenic activities.