Exploration and optimization of surgical techniques for laparoscopic transhiatal lower mediastinal lymph node dissection for adenocarcinoma of esophagogastric junction: A prospective IDEAL 2a study with qualitative design

Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.

Ethylene Emission as a Potential Indicator of Fuji Apple Flavor Quality Evaluation Under Low Temperature

Fuji apple(Malus×domestica Borkh.)is a popular fruit cultivar and occupies an important position in the fruit market due to its excellent flavor and storage quality.Ethylene emission can induce respiration,which would reduce postharvest quality and increase storage losses.In order to maintain fruit quality and extend shelf life,apples are usually stored in a low-temperature environment after harvest to reduce the formation of ethylene.Volatile aroma components are regarded as one of the most important aspects of flavor quality and a key factor for apple quality grading and customer satisfaction.Ethylene emission and its relationship with volatile aromas during low temperature,however,have not been determined.In this study,the dynamic changes of volatile aroma compounds of Fuji apples stored at 4°C were detected and analyzed for 42 days.The variation of ethylene released from Fuji apple was studied correspondingly.The results showed that ethyl butyrate,ethyl caproate,ethyl 2-methylbutyrate and 2-methylbutyl acetate were the main aroma components of Fuji apple.The change in ethylene emission and the normalized peak area of volatile aroma compounds exhibited a similar tendency that increased significantly from the 3rd day to the peak on the 14th day and then decreased;there was a positive linear correlation between them with a correlation coefficient of 0.79(P<0.05).Therefore,ethylene release can be used as a potential indicator for evaluation of volatile aroma compounds in apples.Using ethylene emission as an indicator could reduce the difficulty and complexity of volatile aroma evaluation,which could be a new non-destructive inspection choice for apple flavor quality assessment.

Depth of tumor invasion and tumor-occupied portions of stomach are predictive factors of intra-abdominal metastasis

Objective： Diagnostic laparoscopy is recommended for the pretherapeutic staging of gastric cancer to detect any unexpected or unconfirmed intra-abdominal metastasis. The aim of this study was to evaluate the role and indications of diagnostic laparoscopy in the detection of intra-abdominal metastasis. Methods： Standard diagnostic laparoscopy with peritoneal cytology examination was performed prospectively on patients who were clinically diagnosed with primary local advanced gastric cancer （CT≥2M0）. We calculated the rate of intra-abdominal metastases identified by diagnostic laparoscopy, and examined the relationship between peritoneal dissemination （P） and cytology results （CY）. Split-sample method was applied to find clinical risk factors for intra-abdominal metastasis. Multivariate logistic regression analysis and receiver-operator characteristic （ROC） analysis were performed in training set to find out risk factors ofintra-abdominal metastasis, and then validate it in testing set. Results： Out of 249 cM0 patients, 51 （20.5%） patients with intra-abdominal metastasis were identified by diagnostic laparoscopy, including 20 （8.0%） P1CY1, 17 （6.8%） POCY1 and 14 （5.6%） P1CY0 patients. In the training set, multivariate logistic regression analysis and ROC analysis showed that the depth of tumor invasion on computer tomography （CT） scan ≥21 mm and tumor-occupied 〉2 portions of stomach are predictive factors of metastasis. In the testing set, when diagnostic laparoscopy was performed on patients who had one or two of these risk factors, the sensitivity and positive predictive value for detecting intra-abdominal metastasis were 90.0% and 32.1%, respectively. Conclusions： According to our results, depth of tumor invasion and tumor-occupied portions of stomach are predictive factors ofintra-abdominal metastasis.

Laparoscopic vs.open lower mediastinal lymphadenectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction:An exploratory,observational,prospective,IDEAL stage2b cohort study(CLASS-10 study)

Objective:This study aims to verify the feasibility and efficacy of laparoscopic lower mediastinal lymphadenectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction(AEG).Setting:An exploratory,observational,prospective,cohort study will be carried out under the Idea,Development,Exploration,Assessment and Long-term Follow-up(IDEAL)framework(stage 2 b).Paritcipants:The study will recruit 1,036 patients with cases of locally advanced AEG(Siewert typeⅡ/Ⅲ,clinical stage cT2-4 aN0-3 M0),and 518 will be assigned to either the laparoscopy group or the open group.Interventions:Patients will receive lower mediastinal lymphadenectomy along with either total or proximal gastrectomy.Primary and secondary outcome measures:The primary endpoint is the number of lower mediastinal lymph nodes retrieved,and the secondary endpoints are the surgical safety and prognosis,including intraoperative and postoperative lower-mediastinal-lymphadenectomy-related morbidity and mortality,rate of rehospitalization,R0 resection rate,3-year local recurrence rate,and 3-year overall survival.Conclusions:The study will provide data for the guidance and development of surgical treatment strategies for AEG.Trial registration number:The study has been registered in ClinicalTrials.gov(No.NCT04443478).

Urban Residents' Consumption Risk Perception about the Dairy Products

Based on the continuous downturn puzzle of Chinese dairy consumption,with the perception of consumption risk as a starting point,the paper deeply analyzes the main factors which cause the downturn of dairy product consumption of Chinese residents. The results show that the income elasticity of dairy consumption of Chinese urban residents is still notable; the occurrence of dairy safety incidents improves the perception of consumption risk,and accordingly it reduces the promoting role of income to the dairy consumption; the safety incident is the key factor which leads to the fall of dairy consumption of urban residents in recent years,and the perception of consumption risk of lower income group is clearly higher than that of higher income group.

Solar cells based on doubly concerted companion dyes with the efficiencies modulated by inserting an ethynyl group at different positions

To develop efficient sensitizers for dye-sensitized solar cells(DSSCs),we recently reported doubly concerted companion(DCC)dye XW83 with a wrapped porphyrin sub-dye unit linked to an organic sub-dye unit through a flexible chain,which exhibits panchromatic absorption and excellent anti-aggregation ability.To further improve the absorption,we herein report XW87 and XW88 by inserting an ethynyl group into the organic sub-dye unit of XW83 near the donor and acceptor,respectively.For the corresponding organic dyes Z3 and Z4,the introduced ethynyl group improves their absorption,but induces aggravated charge recombination,leading to lowered power conversion efficiencies(PCEs).Similar to the organic dyes,the introduced ethynyl group improves the absorption of DCC dyes XW87 and XW88 as well.In addition,the ethynyl group near the acceptor of the organic sub-dye unit can be well protected by the long wrapping chains from the porphyrin unit.As a result,XW88 affords the highest JSC(21.84 mA/cm^(2)),V_(OC)(782 mV)and PCE(12.2%)among the DCC dyes.These results provide an effective method for developing efficient DSSC dyes by inserting an ethynyl group at a suitable position of a DCC dye.