The incidence of esophagogastric junction adenocarcinoma is gradually increasing, and gastrointestinal surgery and thoracic surgery are paying more and more attention to its surgical treatment. “Chinese expert consensus on the surgical treatment of adenocarcinoma of esophagogastric junction (2018 edition)” discussed the core issues in the field of surgical treatment such as definition, classification, surgical approach, lymphadenectomy, digestive tract reconstruction, and neoadjuvant therapy for esophagogastric junction adenocarcinoma, and gave recommendations. However, there is still some controversy about these issues. The author discussed the consensus and controversial issues relevant to esophagogastric junction adenocarcinoma and related research progress in recent years.
Objective To determine the oncological outcomes following the intersphincteric resection (ISR) for lower rectal cancer and influencing factors. Methods Reviewed the reports on ISR for lower rectal cancer, and summarized the oncological outcomes and influencing factors. The oncological outcomes included local and distant recurrence rates, postoperative survival, and mortality rates. Tumor indicators, surgical techniques, and perioperative radiochemotherapy were included in the influencing factors. Results The recurrence, survival, and mortality rates following ISR resemble traditional operations. Higher stages, metastasis, and non-standard operations affect the oncological outcomes significantly. Preoperative radiochemotherapy could improve the efficacy, but probably at the cost of postoperative anal function. Conclusions The oncological outcomes following ISR are acceptable. The careful case selection and rational arrangements of radiochemotherapy will allow better outcomes.
ObjectivesTo systematically review the association between bullying and risk of non-suicidal self-injury among adolescents.MethodsPubMed, MEDLINE, EMbase, The Cochrane Library, CNKI and WanFang Data were searched from inception to September 1st 2017 to collect studies on the association between bullying and non-suicidal self-injuries. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies by Agency for Healthcare Research and Quality (AHRQ). Then, meta-analysis was performed using CMA 2.2 software.ResultsA total of 23 studies involving 18 819 participates were finally included. The results of meta-analysis showed that bullying victims reported more NSSI than uninvolved adolescents (OR=2.41, 95%CI 1.96 to 2.96, P<0.001). The bullying perpetrators reported more NSSI than uninvolved adolescents (OR=2.26, 95%CI 1.39 to 3.68,P=0.001). Individuals acting as both victims and perpetrators could also increase risks of NSSI (OR=2.76, 95%CI 1.17 to 6.51, P=0.02). Using meta-regression, it was found that the relation between NSSI and bullying victimization was significantly moderated by age, with studies in which respondents were younger reporting larger effect sizes than studies in which respondents were older (B=–0.33, 95%CI –0.38 –0.28, P<0.001).ConclusionsThe current study demonstrates that involvement in bullying in any capacity is associated with non-suicidal self-injuries. Due to the limitation of research, more studies are required to verify above conclusions.
Objective To investigate the variation of total hospitalization cost for single-diagnosed disease of different types of acute appendicitis in a three-A hospital, so as to provide evidence for the reimbursement amount of social medical insurance. Methods All patients with acute appendicitis who had surgery treatment during January-April 2011 (before implementing the fee system for single-diagnosed disease) and January-April 2012 (after implementing the fee system for single-diagnosed disease) were collected in this study for analysis. According to the types of acute appendicitis, the patients were stratified into the low risk group (simple, suppurative and gangrenous) and the high risk group (perforative, abscess-formed and pregnancy-combined). The correlation between total hospitalization cost and types of acute appendicitis, as well as the changes of total hospitalization cost after implementing the fee system for single-diagnosed disease were analyzed. Results A total of 90 eligible patients were included. The disease types were positively correlated with hospital stays and total hospitalization cost. All three types in the low risk group could control the average total hospitalization cost within RMB 10 000 yuan. The results of sensitivity analysis showed that, before implementing the fee system for single-diagnosed disease, the total hospitalization cost up to RMB 6 000 yuan could be positively correlated with the above risk stratification (r=0.442, P=0.003). After implementing the fee system for single-diagnosed disease from January to April 2012, the constituent ratio of hospital stays, compared with that in the same period of 2011, had no significant difference (P=0.108) between the two groups; but the ratio of hospital stays (less than 5 days) increased from 45% to 64%, and the ratio of hospital stays (greater than or equal to 10 days) decreased from 17% to 4%, indicating a tendency of shortening hospital stays. Also, the constituent ratio of total hospitalization cost had no significant difference (P=0.114) between the two groups; but the ratio of total hospitalization cost (greater than or equal to RMB 9 000 yuan) decreased from 32% to 13%, indicating a tendency of lowering total hospitalization cost. Conclusion The low risk group of acute appendicitis, RMB 6 000 yuan should be rated as the rational reimbursement amount of social medical insurance. The total hospitalization cost for the high risk group is quite various, so the further studies are needed to investigate the feasibility of the fee system for single-diagnosed disease as well as the rating amount of total hospitalization cost. The implementation of the fee system for single-diagnosed disease is helpful to shorten hospital stays and reduce total hospitalization cost.
Modern medicine is being transferring from traditional "empirical medicine" to more scientific "evidence-based medicine", which embodies the idea that clinical research is a primary motive that keeps medical practice continuously developing. Therefore, the contemporary aim of medical education should focus on attaching great importance to and strengthen the training of medical students' clinical scientific research ability. Based on clinical departments, we have built an open research project platform for volunteers for medical students before engaging in medical practice. Through a spirally-progressing teaching mode of "Training-Practice-Assessment-Retraining" for medical students before engaging in medical practice, the platform provides training on the knowledge and skills of evidence-based medicine and clinical scientific research. Through the volunteers' active and omnibearing practice, this project achieves some good outcomes in teaching and learning experience. This extracurricular teaching mode provides a platform for scientific research volunteers with the capacity for more knowledge before engaging in medical practice, which is recommended to empower the students with ability of scientific research.
Medical education is undergoing the transition from traditional classroom teaching to more diversified " inside-and-outside-class collaborative teaching”, that is, extracurricular teaching has become an important supplement to medical education. The academic societies of medical students are important platforms in medical education. With the increasing of academic societies in medical colleges, the coordination and balance between community construction and student development requires deep thinking and investigation. The society should develop under the ideas of " following the initial intention - realizing transformation - promoting innovation”. The society-based extracurricular teaching should be performed in the manner of capacity-directing " translational teaching”. The society needs to carry out the " personalized and advanced” training to improve the scientific research or innovation capacity of individual medical student. This paper aims to discuss key points on the construction and management of academic society of medical students at the micro-level, to provide references for single society’s development.
Objectives To investigate contents and clinical significances of CD19+IL-10+ B cell and its subsets in peripheral blood monouclear cell (PBMC) and cancer tissue of patient with colorectal cancer (CRC). Methods Thirty-eight patients with CRC underwent surgery from November 2017 to November 2018 in this hospital were enrolled as a trail group. The proportions of CD19+IL-10+ B cell, CD19+IL-10+CD24hiCD38hi B cell, CD19+IL-10+CD24intCD38int B cell, and CD19+IL-10+CD24hiCD38– B cell in the CD19+ B cells in the PBMC, cancer tissue and paracancer tissue of these patients were detected by the flow cytometry. Thirty-seven healthy volunteers were selected as a control group and the same cell types same as the trail group were detected by the same method in the PBMC only. Results ① The contents of CD19+IL-10+ B cell and CD19+IL-10+CD24hiCD38hi B cell of the PBMC in the trail group were significantly higher than those in the control group (t=9.09, P<0.01; t=9.36, P<0.01, respectively), which of the cancer tissues in the trail group were significantly higher than those in the corresponding paracancer tissues (t=11.67, P<0.01; t=19.64, P<0.01, respectively), while the content of CD19+IL-10+CD24hiCD38– B cell of the PBMC in the trail group was significantly lower than that in the control group (t=6.15, P<0.01). But the CD19+IL-10+CD24intCD38int B cell had no significant difference of the PBMC between these two groups (t=1.78, P=0.08). ② The contents of CD19+IL-10+ B cell and CD19+IL-10+CD24hiCD38hi B cell of the PBMC in the CRC patients with stage Ⅲ+Ⅳ were significantly higher than those in the CRC patients with stage Ⅰ+Ⅱ (t=5.39, P<0.01; t=3.13, P<0.01, respectively). The others all had no significant differences (P>0.05). Conclusion CD19+IL-10+ B cells are significantly increased in PBMC and cancer tissue of patient with CRC and with advanced CRC (TNM stage Ⅲ+Ⅳ), further more, main increasing subgroup of CD19+IL-10+ B cell is CD19+IL-10+CD24hiCD38hi B cell, which indicates that CD19+IL-10+ B cell and CD19+IL-10+CD24hiCD38hi B cell might participate in tumorigenesis and tumor progress of CRC.
ObjectiveTo study the safety of right vertical infra-axillary thoracotomy (RVIAT) in the repair of ventricular septal defect (VSD) and the optimal age for RVIAT.MethodsBetween June 2014 and June 2018, 441 children underwent VSD repair via RVIAT in our hospital. According to the age, they were divided into four groups: a 4 months to 1 year old group (R1 group, n=123), a 1-2 years old group (R2 group, n=106), a 2-5 years old group (R3 group, n=166), a >5 years old group (R4 group, n=46). The clinical effects of the patients were compared.ResultsAll the operations were successfully performed and no serious complication was found in all groups. No statistical difference was observed in the operation time, blood loss during operation, thoracic drainage 24 h after operation among groups (P>0.05). The cardiopulmonary bypass time, aortic cross-blocking time and ICU stay time in the R1 and R2 groups were longer than those in the R3 and R4 groups (P<0.05). In the R1 group, the postoperative ventilating time and postoperative hospital stay time were longer, and the blood transfusion volume was more than those in the R3 and R4 groups (P<0.05). The incidence of postoperative complications was higher in the R4 group than that in the R1 and R3 groups (P<0.05).ConclusionVSD repair via RVIAT may be more effective in children >2 years old, and 2-5 years old may be the optimal age.
ObjectiveTo explore the diagnostic value of “Four-Step Procedure” of laparoscopic exploration in patients with peritoneal metastasis of gastric cancer.MethodsWe retrospectively collected the data of 409 gastric adenocarcinoma patients from July 2016 to August 2020 who underwent “Four-Step Procedure” of laparoscopic exploration in West China Hospital. The descriptive case series study was conducted to analyze the outcome of laparoscopic exploration combined with CY (cytology test), stepwise treatment plans, and the rates of CY1 and P1 (peritoneal metastasis) among cT3–4 patients during different periods. SPSS 22.0 software was used to conduct the univariate and multivariate logistic regression to analyze the high risk factors associated with P1 and (or) CY1.ResultsA total of 409 gastric adenocarcinoma patients who underwent laparoscopic exploration were enrolled in our study. Among them, 65 patients were confirmed to be P1 and (or) CY1. Stratified analysis by cT and cN staging showed that there were 7 (7.4%) and 55 (27.9%) patients with peritoneal metastasis in cT3 staging and cT4 staging, respectively. After laparoscopic exploration, 168 patients received laparoscopic gastrectomy, 35 patients received laparotomy, 143 patients received neo-adjuvant chemotherapy, and 63 patients received conversion therapy. The bar chart showed an ascending tendency in the diagnosis rate of P1 over time among cT3–4 patients. Multivariate logistic regression analysis showed that ascites was an independent risk factor of CY1 and (or) P1 (P<0.001). Additionally, the postoperative complication rate was 2.9% in the patients who merely underwent laparoscopic exploration, including 4 patients with pulmonary infection and 2 patients with urinary retention.Conclusions“Four-Step Procedure” of laparoscopic exploration is reliable and feasible for gastric cancer. “Four-Step Procedure” of laparoscopic exploration has high diagnostic value for peritoneal metastasis of gastric cancer. Our study shows that most of peritoneal metastasis distribute in cT3 and cT4 patients. For these patients, laparoscopic exploration should be recommended to identify if peritoneal metastasis exists and avoid unnecessary laparotomy.