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We aimed to assess whether the Response Evaluation Criteria in Solid Tumors (RECIST)-based objective response rate (ORR), disease control rate (DCR) and progression-free survival (PFS) could serve as surrogate endpoints for overall survival (OS) in immune-oncology (IO) trials of advanced gastro-esophageal (GE) carcinoma.Randomized controlled trials (RCTs) of IO that reported RECIST-based endpoints and OS in advanced GE carcinoma were screened. Surrogacy of endpoints for OS was assessed based on the correlation between endpoints with OS (arm-level), and between treatment effects on endpoints (trial-level). The correlations were quantified by Pearson correlation coefficient (R). Leave-one-out cross-validation was used to assess the prediction accuracy of surrogate model.Seventeen RCTs (9,657 subjects) with 20 comparisons were included. The correlations between DCR and OS were not strong at arm- (R = 0.80) and trial-levels (R = 0.45), but strong correlations between ORR (R = 0.91), PFS (R = 0.89) and OS at arm-level were observed. Treatment effect on ORR and PFS (both R = 0.71) was moderately correlated with treatment effect on OS. Leave-one-out cross-validation approach further validated the surrogacy of PFS. Our analysis showed that 3-month PFS could reliably predict 6-month OS, 6-month PFS could reliably predict 12-month OS, and 12-month PFS could reliably predict 18-month OS. The conservative minimum threshold effect of HRPFS may be the appropriate surrogate for OS in IO trials of GE carcinoma. A conservative minimum threshold effect of HR

Although the incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing since the past decade, the proportion of AEG cases in two previous clinical trials (ACTS-GC and CLASSIC) that investigated the efficacy of adjuvant chemotherapy was relatively small. Therefore, whether AEG patients can benefit from adjuvant chemotherapy remains unclear.Patients who were diagnosed with pathological stage II/III, Siewert II/III AEG, and underwent curative surgery at three high-volume institutions were assessed. Clinical outcomes were analyzed by using Kaplan-Meier curves, log-rank test, and Cox regression model. Propensity score matching (PSM) was used to reduce the selection bias.A total of 927 patients were included (the chemotherapy group: 696 patients; the surgery-only group: 231 patients). The median follow-up was 39.0 months. The 5-year overall survival was 63.1% (95% confidence interval [CI]: 59.0-67.6%) for the chemotherapy group and 50.2% in the surgery-only group (hazard ratio [HR] = 0.69, 95% CI: 0.54-0.88; p = 0.003). The 5-year, disease-free survival was 35.4% for the chemotherapy group and 16.6% for the surgery-only group (HR = 0.66, 95% CI: 0.53-0.83; p0.001). After PSM, the survival benefit of adjuvant chemotherapy for AEG was maintained. Multivariate analysis for overall survival and disease-free survival further demonstrated the survival benefit of adjuvant chemotherapy, with HRs of 0.63 (p0.001) and 0.52 (p0.001), respectively.Postoperative adjuvant chemotherapy was associated with improved overall survival and disease-free survival in patients with operable stage II or III AEG after D2 gastrectomy.

OBJECTIVE To compare the inhibition of lymphocyte-activation gene 3 (LAG3) plus programmed cell death 1 (PD-1) versus the inhibition of cytotoxic T-lymphocyte antigen 4 (CTLA-4) plus PD-1 in patients with previously untreated advanced melanoma.DESIGN A meta-analysis of individual participant data (IPD).DATA SOURCES PubMed, Web of Science and Embase were searched from January 1, 2015, to January 14, 2022, for eligible studies.ELIGIBILITY CRITERIA FOR STUDY SELECTION Data from randomized controlled trials reporting on the use of dual LAG3-PD1 inhibitors or dual CTLA4-PD1 inhibitors which assigned PD1 inhibitor alone as their control arm and provided corresponding Kaplan-Meier (KM) curves of treatment outcomes for previously untreated advanced melanoma were retrieved. METHODS The IPD data were extracted from the KM plots using a graphical reconstructive algorithm. Log-rank, Cox proportional hazard model, Bayesian hierarchical model with time-varying hazard ratio (HR) effect, and restricted mean survival time (RMST) were performed to estimate survival benefits. The primary endpoint was progression-free survival.RESULTS The CheckMate-067 (N = 630) and RELATIVITY-047 (N = 714) trials were included for analysis. The graphical reconstructive algorithm showed that IPD had similar HRs and log-rank values as the original plots. The HR of nivolumab-relatlimab (LAG3 inhibitor) versus nivolumab-ipilimumab (CTLA4 inhibitor) was 1.19 (95% confidence interval [CI] 0.96 to1.48). The 24-months RMST of nivolumab-relatlimab versus nivolumab alone was 2.35 (95% CI 0.77 to 3.94) months, compared with 1.87 (95% CI 0.25-3.49) months for nivolumab-ipilimumab versus nivolumab. The Bayesian hierarchical model showed that patients treated with nivolumab-relatlimab had earlier PFS benefits than those with nivolumab-ipilimumab. Grade 3 or 4 treatment-related adverse events occurred in 18.9% of patients using nivolumab-relatlimab and 55.0% of patients using nivolumab-ipilimumab.CONCLUSION These findings suggest that the PFS of LAG3-PD1 and CTLA4-PD1 inhibition were similar and that LAG3-PD1 inhibition tended to exhibit earlier survival benefit and lesser TRAEs.

Background: Increasing numbers of Gastric cancer(GC) patients were diagnosed at younger age with aggressive behavior including early disease recurrence, more frequent peritoneal metastasis and poor overall survival. To investigate the driver genes and mechanisms of the early-onset and more aggressive nature of the GC.Methods: Gastric adenocarcinoma and matched germline samples were obtained from patients in Sun Yat-sen University Cancer Center between 2007 and 2013. Exome sequencing were performed for 198 pairs of primary gastric adenocarcinoma fresh tissue and blood samples from young or elder patients. Besides, matched tumor / blood exome sequencing was performed in 80 patients with peritoneal seeding and 51 patients without. Then bioinformatics analysis was performed to find genomic variants and their clinical meanings.Results: Early-onset gastric cancers (EOGCs) have fewer somatic mutations but some deleterious germline variates in FAT genes, patients carried none, one, two, three of the 4 Single nucleotide polymorphisms (SNPs), the mean ages of diagnosis are 60, 50, 40 and 35 respectively. Somatic mutations in CDH1, TGFBR1 and CTNNB1 are related to early-onset cancers. These variants are all linked to WNT pathways. Somatic mutations in genes involved in cancer aggressiveness like MAP2K7, CDH1 and RhoA are related to cancer progression and metastasis. Patients carrying RhoA, ITGAV, TGFBR1, CDH1, CTNNB1, MYO9B, VAV1, SALL1, CDX4 somatic mutations or simultaneously carrying three FAT germline SNPs have been diagnosed at younger age than those have only TP53 mutations.Conclusions: The molecular characterization gives us a novel insight into the carcinogenesis and tumor progression mechanisms and may provide a guide to developing novel targeted therapy in GC.

Background: We aimed to assess whether disease-free survival (DFS) could serve as a reliable surrogate endpoint for overall survival (OS) in adjuvant trials of pancreatic cancer. Methods: We systematically reviewed adjuvant randomized trials for non-metastatic pancreatic cancer after curative resection that reported a hazard ratio (HR) for DFS and OS. We assessed the correlation between treatment effect (HR) on DFS and OS, weighted by sample size or precision of hazard ratio estimate, assuming fixed and random effects, and calculated the surrogate threshold effect (STE). We also performed sensitivity analyses and a leave-one-out cross validation approach to evaluate the robustness of our findings. Results: After screening 450 relevant articles, we identified a total of 20 qualifying trails comprising 5170 patients for quantitative analysis. We noted a strong correlation between the treatment effects for DFS and OS, with coefficient of determination of 0.82 in the random effect model, 0.82 in the fixed effect model, and 0.80 in the sample size weighting; the robustness of this finding was further verified by the leave-one-out cross-validation approach. Sensitivity analyses with restriction to phase 3 trials, large trials, trials with mature follow-up periods, and trials with adjuvant therapy versus adjuvant therapy strengthened the correlation (0.75 to 0.88) between DFS and OS. The STE was 0.96 for DFS. Conclusions: Therefore, DFS could be regarded as a surrogate endpoint for OS in adjuvant trials of pancreatic cancer. In future similar adjuvant trials, a hazard ratio for DFS of 0.96 or less would predict a treatment impact on OS.

Background High body mass index (BMI) is thought to be a preoperative risk factor for surgical treatment. Until now, few studies have investigated the long-term impact of preoperative high BMI on advanced gastric cancer (GC) patients who underwent laparoscopic gastrectomy (LG). Therefore, the present study was designed to compare clinical outcomes between high BMI and normal BMI patients who underwent LG. MethodsWe retrospectively investigated 282 pathological stage II~III GC cases who underwent radical LG plus D2 lymphadenectomy from February 2009 to May 2018. Based on the China BMI classification, the patients were classified into a high (BMI ≥ 24 kg/m2) or normal (BMI < 24 kg/m2) BMI group. The clinical characteristics, intraoperative findings, short-term and long-term outcomes of the two groups of patients were then compared. Results The high BMI group had longer operation time (160.1 ± 36.0 minutes vs. 147.7 ± 33.7 minutes; P = 0.005) and greater intraoperative bleeding (138.3 ± 239.4ml vs. 86.6 ± 67.7ml; P = 0.002) compared to the normal BMI group. Moreover, shorter time to flatus, starting the soft diet, removing drain tube and length of stay (all P < 0.05) were observed in the high BMI patients. However, there was no significant difference in relapse-free survival or overall survival between the two groups. Conclusion Patients with high BMI was associated with longer operation time and greater amount of intraoperative bleeding but had faster recovery as compared to those with normal BMI. Also, LG can be considered as safe with no significant difference in terms of short- and long-term outcomes on the peri- and post-operative outcomes between the two BMI groups of patients. Nevertheless, these surgeries for high BMI patients should be performed by experienced surgeons.

Supplementary materials. (DOCX 307 kb)

Four quadrant inverter used for mine consists of SEOHO[1] inverter of South Korean and explosion-proof cabinet and a series of hardwares and softwares (be in conformity with safety standards of mine). Applied in coal mine machines, making reasonable braking by using the principle of energy feedback. It can meet the special requirements of the mine lifting equipment, and providing the energy feedback to grid so as to strengthen braking effect and so on. In addition, SEOHO inverter of the South Korean has a special active-front-end (AFE), AFE rectifier unit/feedback [2] derive sine wave AC from the grid, generating DC voltage output by rectification, and maintaining the required voltage value. Every harmonic wave is deleted by filter circuit. Meanwhile, the huge economic benefits and energy-saving profits have been gained when the four quadrant inverter is used.

According to the theory of solar energy and vibration energy harvesting, an energy harvesting system based on energy conversion scavenging technology has been designed to convert the solar energy and vibration energy into the electric power. Piezoelectric materials and the solar cells are used as core power conversion section, and the system also consists of the lithium battery charge chip, the rectifier, comparators and switch chips as the control segments, combined with the super capacitor, etc. The energy harvesting experiment shows that the lithium battery can be charged through solar and vibration by the solar and vibration energy harvesting system, and the charging chip adopted in this work has input voltage limited current mode which can fulfill intermittent charge smoothly.

In this paper, a measurement system is designed to deal with the problem of measurement of the coal moisture content. Based on the measurement principle including standing-wave ratio and permittivity, develop the whole measurement system from the hardware and software aspects. The measurement system of coal moisture content based on standing-wave ratio has the advantages of less measuring time, higher accuracy and larger measurement range according to the results. And it can apply in the coal moisture content measurement in many industry fields.

Treat the upper plate and lower plate of ribbed hollow floor as the surfaces of sandwich panel, and the ribbed hollow layer as the central layer of sandwich panel; consider the bending stiffness of the surfaces and transverse shear deformation of the central layer; use Hoff laminated theory; based on the same stiffness principle; establish sandwich panel structure model of hollow floor; Derive partial differential equations of cast-in-place reinforced concrete two-way ribbed and thin-walled hollow floor under vertical uniform load and present the analytic solution of the equations with two opposite clamped edges and others simply supported edges. Analyze the mechanical properties of hollow floor. The results are very close to the results of using finite element method.

Considering the hooping effect between steel tube and core concrete, established a small-deformation elastic analysis theory for the concrete-filled rectangle steel tube (CFRST) member, founded the elastic constitutive relations of CFRST, and accomplished the semi-analytical and semi-numerical solution of the composite elastic modulus. Research shows: composite elastic modulus of CFRST is higher than conversion elastic modulus without considering the hooping effect. Within certain value range of parameters, composite elastic modulus is 1.36% - 15.3% higher than conversion elastic modulus. Further more, as the steel ratio increases, the composite elastic modulus increases significantly, but the sensitivity of the composite elastic modulus to the strength of concrete is small.

Phase inversion of polymer solution by immersion-precipitation method was used to prepare porous hollow capsule nickel boride composite. The composite was used as a carrier for sodium borohydride, in which sodium borohydride was absorbed into the capsules or embedded in the capsules during the processing of capsules formation. The preparation method and adsorption property of the polymer capsules were studied. The effect of capsules structure on the storage capacity of sodium borohydride was investigated. The results showed that capsules prepared by 18wt% of PVDF-DMF solution with adding 15% PVP had the best adsorption capacity. While capsules prepared by PVA had better affinity to water, this made them easier to absorb sodium borohydride in the aqueous solution.

Aim. To investigate whether tumor size is a reasonable indication for adjuvant chemotherapy for T3-4aN0M0 gastric cancer patients after D2 gastrectomy. Method. We performed a retrospective study of 269 patients with a histological diagnosis of T3-4aN0M0 stage gastric cancer who underwent D2 radical surgery at the Sun Yat-sen University Cancer Center or the Sixth Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2010. The follow-up lasted until June of 2015. Chi-square tests and Kaplan-Meier methods were employed to compare the clinicopathological variables and prognoses. Result. For this group of patients, univariate analyses revealed that tumor size (p < 0.001), pathological T stage (p < 0.001), and tumor location (p = 0.025) were significant prognostic factors. Adjuvant chemotherapy did not exhibit prognostic benefits. For patients with tumors larger than 5 cm, univariate analysis revealed that tumor location (p = 0.007), Borrmann type (p = 0.039), postoperative chemotherapy (p = 0.003), and pathological T stage (p < 0.001) were significant prognostic factors. Multivariate analysis revealed that postoperative chemotherapy and pathological T stage were independent prognostic factors. Conclusion. Our results imply that tumor size should be a critical factor in the decision to utilize adjuvant chemotherapy for T3-4aN0M0 gastric cancer patients after D2 gastrectomy. Additional randomized controlled trials are required before this conclusion can be considered definitive.

Keywords: concrete-filled steel tube, rectangle cross-section, hooping force, interfacial mechanics Abstract: One of the mechanical key problems on concrete-fill ed steel tube (CFT) structure is the confining effect between the steel tube and the core concrete. The key technology to solve the problem is to accurately describe the interfacial mechanics properties. Based on continuum mechanics theory, by means of the solving method on plane problem in elasticity and structural mechanics displacement solution, using the function expression to describe the interfacial normal force distribution, a small-deformation elasticity analysis theory on the interfacial mechanics problem is framed for the CFT structure. The results show: The hooping force distribution in the interface between the core concrete and the steel tube is not uniform. The hooping force in the long side of rectangle is smaller than one in the short side of rectangle.

CD44 and CD133 have been reported as putative stem cell markers. However, the clinicopathologic significance of CD44 and CD133 expression in patients with gastric carcinoma (GC) has not been clearly elucidated.Immunohistochemistry (IHC) was performed to investigate the CD44 and CD133 expression in gastric carcinomas and normal mucosal tissues. Receiver operating characteristic (ROC) curve analysis, spearman's rank correlation, Kaplan-Meier plots, and Cox proportional hazards regression model were used to analyze the data.The highly expressed CD44 and CD133 were observed in 27/152 (17.7%) and 64/152 (42.1%) of GCs and in 4/60 (6.7%) and 15/60 (25.0%) normal gastric mucosal tissues, respectively (P0.05, Fisher's exact test). High expression of CD44 was significantly correlated with tumor poorer differentiation, presence of distant metastasis, advanced TNM stage, and tumor relapse; and high expression of CD133 was positively associated with tumor invasion depth, presence of distant metastasis and advanced TNM stage. More importantly, high-expressed CD44 and CD133 were both associated with shorter survival as evidenced by univariate and multivariate analysis.Our study introduces high expression of CD44 and CD133 as adverse independent prognostic factors in GC patients. The combined CD44 and CD133 expression may become a useful tool for identifying patients with different clinical outcomes.

To investigate the clinical significance of the postoperative serum carcinoembryonic antigen (CEA) levels in gastric cancer patients who underwent D2 radical gastrectomy and to identify the prognostic factors for patients with marginally elevated postoperative CEA levels.We performed a retrospective study of 480 patients who were histologically diagnosed with gastric cancer and who underwent D2 radical surgery at the Sun Yat-sen University Cancer Center between January 2004 and December 2009. The follow-up lasted until June 2011. Chi-squared tests and Kaplan-Meier methods were employed to compare the adverse events and prognoses.In this group of gastric cancer patients, the postoperative serum CEA level (P = 0.002) was an independent prognostic factor; the same was true for the histological T and N staging (P0.001 and P = 0.045, respectively). In the group of marginally elevated postoperative CEA level gastric cancer patients, univariate analysis demonstrated that tumor position (P = 0.042); histological grade (P = 0.002); and Boarrmann type (P = 0.003) were significant prognostic factors. Multivariate analysis showed that the tumor position (P = 0.003) and histological grade (P = 0.007) were independent prognostic factors for these patients.Our study showed that patients with normal postoperative CEA levels have a better prognosis. Furthermore, for marginally elevated postoperative CEA level gastric cancer patients, the tumor position and histological grade were two important factors for predicting the prognosis and the need for aggressive therapy.

In both the seventh edition of the International Union Against Cancer (UICC) staging system for gastric cancer and the 14th edition of the Japanese Gastric Cancer Association (JGCA) system, T(4a) is defined as "Tumor perforates serosa (visceral peritoneum) without invasion of adjacent structures." The aim of this study was to investigate the differences in prognosis between patients with serosa-penetrating and serosa-invading T(4a)N(0)M(0) gastric carcinomas.Data were collected from 221 patients with T(4a)N(0)M(0) gastric carcinoma who underwent D2 resection at our cancer center between January 1990 and December 2008. The cohort included 42 patients with serosa-penetrating tumors and 179 patients with serosa-invading tumors. The average follow-up time was 85.5 months. Spearman's rank correlation, Kaplan-Meier plots, and Cox proportional hazards regression models were used to analyze the data.The 5-year survival rate of patients with serosa-penetrating and serosa-invading gastric cancers were 31% and 62% respectively (P0.05). The relapse rates after D2 radical surgery were 16.2% in patients with serosa-invading gastric cancer versus 59.5% in those with serosa-penetrating tumors (P0.05). Peritoneal dissemination and distant organ/lymph node metastatic rates were 76.0% and 24.0% respectively in patients with penetrating tumors, versus 44.8% and 55.2% respectively in patients with invading tumors (P0.05). Multivariate analysis showed that penetration of the serosa was an independent prognostic indicator of overall survival.Our findings provide a basis for the concept that serosa-penetrating T(4a)N(0)M(0) gastric carcinoma represents a more aggressive cancer than serosa-invading T(4a)N(0)M(0) gastric carcinoma. Serosa penetration is an independent factor for poor prognosis of patients with gastric carcinoma.

To investigate the significance of palliative gastrectomy for different types of metastatic gastric cancer patients displaying peritoneal dissemination, hepatic metastasis, distant lymph node metastasis occurring locally during late-stage disease, and multi-organ metastases.We performed a retrospective study of 862 patients who were histologically diagnosed as late-stage gastric cancer who could not undergo radical surgery at the Sun Yat-sen University Cancer Center between January 1993 and December 2008. The follow-up lasted until December 2010. Chi-square tests and Kaplan-Meier methods were employed to compare the adverse events and prognoses.In the peritoneal dissemination and multi-organ metastases groups, palliative gastrectomy has no survival benefit (P = 0.705, 0.331, respectively). In the patients with distant lymph-node metastases, liver metastasis and locally late-stage gastric cancer patients, palliative gastrectomy was a prognostic factor (P 0.001, P 0.001, P = 0.010, respectively). Multivariable analysis demonstrated that palliative gastrectomy was an independent prognostic factor for distant lymph-node metastases, liver metastasis, and local late-stage gastric cancer patients. Palliative gastrectomy combined with hepatectomy proved to be an independent prognostic factor to improve the overall survival of patients with liver metastases who underwent palliative gastrectomy (P = 0.008).For late-stage gastric cancer patients, palliative gastrectomy should be considered for locally late-stage, distant lymph node metastasis, and resectable liver metastasis patients. Especially among patients with liver metastasis, transfer medicine is essential for potentially curable patients to obtain access to radical surgery to improve the prognosis.

To evaluate the influence of two different types of digestive tract reconstruction on the life quality, nutritional status and tolerance to adjuvant chemotherapy after total gastrectomy in patients with gastric carcinoma.The clinical data of a total of 107 patients treated in our department from January 2005 to december 2008 were analyzed retrospectively. Among them, 49 patients underwent digestive tract reconstruction with functional jejunal interposition (FJI group) and 58 patients underwent Roux en-Y jejunal P-type anastomosis (PR group) after total gastrectomy. 79 of 107 (73.8%) patients received postoperative adjuvant chemotherapy with XELOX regimen. The digestive complications and tolerance to chemotherapy were assessed respectively.Neither severe complications nor surgery-related or chemotherapy-related death were observed among the 107 patients. There were statistical differences in the incidence rate of emaciation, dumping syndrome and retention syndrome between the FJI and PR groups (P0.05), but no significant statistical difference in incidence rate of reflux esophagitis (P0.05). 28 of 40 (70.0%) patients in the FJI group completed all six cycles of chemotherapy, while 12 (30.0%) patients interrupted the treatment due to chemotherapy-related toxicity. 39 patients in the PR group received chemotherapy, 19 (48.7%) of them completed 6 cycles of chemotherapy but 20 (51.3%) patients interrupted. There was a significant difference in the incidence rate of grade III/IV chemotherapeutic toxicity and completion rate of chemotherapy (P0.05).Both functional jejunal interposition and Roux-Y operation are reasonable and safe procedures of digestive tract reconstruction. The incidence rates of emaciation, dumping syndrome and retention syndrome are lower in the patients with FJI, showing a better tolerance to adjuvant chemotherapy than Roux en-Y jejunal p type anastomosis.

Beclin 1 plays a critical role in the regulation of autophagy, apoptosis, differentiation and the development and progression of cancer. The clinicopathological significance of Beclin 1 expression in patients with gastric carcinoma (GC) has not been yet elucidated.Immunohistochemistry (IHC) was performed to investigate the Beclin 1 expression in GCs and normal mucosal tissues. Receiver operating characteristic curve analysis, spearman's rank correlation, Kaplan-Meier plots and Cox proportional hazards regression model were used to analyze the data.The highly expressed Beclin 1 was observed in 90/155 (58.1%) of GCs, in 24/60 (40.0%) adjacent mucosal tissues and in 13/30 (43.3%) of normal gastric mucosa tissues (P = 0.036). Decreased expression of Beclin 1 in cancer cells was significantly correlated with poor differentiation, nodal and distant metastasis, advanced TNM stage, and tumor relapse. More importantly, Decreased expression of Beclin 1 was associated with shorter survival as evidenced by univariate and multivariate analysis.Our findings provide a basis for the concept that decreased expression of Beclin 1 in GC may be important in the acquisition of a metastatic phenotype, suggesting that decreased Beclin 1 expression, as examined by IHC, is an independent biomarker for poor prognosis of patients with GC.

To explore the relationship between the lymph node count and prognosis in stage II gastric cancer.Retrospective analysis was performed for the 268 cases with gastric cancer who underwent parallel D(2) dissection between January 1990 and December 2006 in the Sun Yat-Sen Cancer Center. The Japanese Gastric Cancer Association(JGCA) 13th edition of pathological staging system was used to define stage II gastric cancer. Patients were followed up until December 2008. The Kaplan-Meier method and chi-square test were used for data analysis. All the data were analyzed using SPSS16.0 for Windows.The average number of detected lymph nodes was 17.3+/-1.2. There were 109 patients with detected lymph node15. The 1-, 3-, and 5-year survival rates were 92.7%, 67.8%, and 50.9%, respectively. The number of detected lymph node wasor =15 in 159 cases, and the 1-, 3-, and 5-year survival rates were 96.9 %, 81.0%, and 66.4%, respectively. The difference between two groups was statistically significant (P=0.003). Further analysis of the 199 cases with no lymph node metastasis (pN(0) group) showed that there were 95 cases with lymph nodes15, and the 1-, 3-, and 5-year survival rates were 92.6%, 70.4%, and 55.9%, respectively. There were 104 patients withor =15 lymph nodes, and the 1-, 3-, and 5-year survival rates were 97.1%, 84.4%, and 66.8%, respectively. The difference was also statistically significant (P=0.049). There were 69 cases with lymph node metastasis (PN(1) group), and the 1-, 3-, and 5-year survival rates of 14 patients with lymph nodes15 were 92.9%,57.1%, and 34.3%, respectively. Comparing two groups, the survival rate was significantly different (P=0.034). There were 55 patients withor =15 lymph nodes, and the 1-, 3-, and 5-year survival rates were 96.4%, 73.4%, and 63.8%. The difference was statistically significant (P=0.036).In patients with stage II gastric cancer as defined by the JGCA 13th edition, the survival rate is better in patients with more than 15 detected lymph nodes as compared to those with less than 15.

To explore the reason, features and preventive measures of residual carcinoma at incisal edge after gastric cancer operation.Clinical data of 108 cases with positive incisal margin(6.47%) from December 1964 to December 2004 in Cancer Center of Sun Yat-sen were summarized and analyzed retrospectively.Positive incisal margin patients accounted for 6.5%(108/1670) of total gastric carcinoma cases during above period. There were 62 men and 46 women with median age of 54 years(ranged from 23 to 82). The residual carcinoma rates of incisal edge were 3.6%(48/1333) in radical resection group and 17.8%(60/337) in palliative resection group respectively(P=0.000). Also, the residual carcinoma rates were 2.3%(3/129) in early group, 6.8(105/1541) in advanced group(P=0.046), 4.5%(37/815) in distal gastrectomy group and 8.0%(55/689) in proximal group respectively(P=0.000). Residual carcinomas were related with pTNM stage, Borrmann type, tumor size, differentiation and invasion depth(P0.05).Superior gastric carcinoma, Borrmann III(, IIII( type advanced cancer, tumor diameteror =5 cm, poor differentiation or undifferentiated type and serosa invaded easily result in residual carcinoma at incisal edge. The radical preventive measure is to ensure that incisal edge ought to exceed 5 cm apart from the tumor.

To probe into the law of acupuncture analgesic effect and specificities of acupoint action.Adult male Kunming mice were randomly divided into a control group, a model group, a model plus electroacupuncture (EA) group and a model plus sham EA group. Chronic inflammatory pain model was prepared by injection of complete Freund's adjuvant (CFA) into right posterior foot, and paw withdrawing latency (PWL) induced by radiation heat was used as pain threshold index, and changes of PWL in all the groups were investigated.After modeling, PWL significantly shortened on the inflammatory side (P0.05); EA at bilateral "Zusanli" (ST 36) and "Kunlun" (BL 60) could significantly reverse the shortened PWL (P0.05), and this effect was prolonged along with increase of EA times, but in the sham EA group PWL did not significantly change; EA at bilateral "Shousanli" (LI 10) and Neiguan" (PC 6) could not reverse the shortened PWL (P0.05).Analgesic effect of EA is strengthened along with increase of EA times and shows specificity of acupoints to a certain extent.

Fulminant hepatic failure can only be treated successfully by liver transplantation, which, however, is not always available. To "bridge" the patient with fulminant hepatic failure until a liver graft is available, various forms of liver support devices had been designed but they were not uniformly successful. To prove the efficacy of a liver support device for fulminant hepatic failure, testing in an animal model is necessary. We attempted to induce a pig model with fulminant hepatic failure by administering galactosamine into pigs and reported the observation. Three pigs were given a dose of 0.5 gm/kg of galactosamine and five pigs were given 1 gm/kg of galactosamine. One pig receiving 0.5 gm/kg galactosamine survived after manifestation of liver failure, while all the other pigs died. The two pigs receiving 0.5 gm/kg galactosamine survived longer than the five pigs receiving 1 gm/kg galactosamine. Before death, a significant elevation of parenchymal liver enzymes, lactate dehydrogenase, bilirubin, bile acid, ammonia, tumour necrosis factor-alpha, activated clotting time, a decrease of platelet concentration, ketone bodies ratio, blood glucose and plasma albumin, and serious impairment of indocyanine green clearance were indicated. At post-mortem, severe liver necrosis was observed. The model may be suitable for testing the efficacy of liver support device for fulminant hepatic failure, preferably 24-48 hours after administration of galactosamine.

To investigate the approaches to improve therapeutic effect of stomach cancer by analysis of the long-term results of surgical treatment of this disease.Prognostic factors of stomach cancer were analyzed by Cox multivariate regression model based on clinical data of 2561 stomach cancer cases who underwent surgical treatment from 1964 to 2004 at Sun Yat-sen University Cancer Center. Survival rates were calculated by life table method.Gastrectomy was performed for 1950 cases with resectability of 76.1%, among which there were 1192 cases of curative resection (46.5%) and 758 cases of non-curative resection (29.6%). The other 611 cases of palliative operation included bypass procedures and laparotomy. Operative mortality of all cases was 0.8% and morbidity was 5.1%. For all cases the 1-, 3- and 5-year survival rate was 52.4%, 38.6% and 35.5%, respectively. The stage-specific 5-year survival rate was 86.8% (Stage I), 58.7% (Stage II), 28.4% (Stage III) and 7.6% (Stage IV), respectively. The 5-year survival after curative resection in the period of 40 years was 45.5%, and increased to 52.7% in the last two decades and 61.8% in recent decade. Stage-specific case proportion during the earlier two decades was 1.4% (Stage I), 10.6% (Stage II), 23.1% (Stage III) and 64.9% (Stage IV), respectively, and that during the recent two decades was 9.3%, 18.5%, 35.3% and 36.8%, respectively. The 5-year survival rate of cases during the earlier two decades was 18.0% and increased to 37.5% during the recent two decades. Multivariate analysis indicated that main prognostic factors of stomach cancer included TNM staging, curative resection and multidisciplinary treatment.Early detection and curative resection were the most important measures to improve therapeutic effect of stomach cancer. A surgery-predominant multidisciplinary treatment individualizing biological characteristics of tumor, staging of disease and tumor site will contribute to improvement of therapeutic effect of stomach cancer.

The resection boundary for gastric cancer is controversial. The study was designed to investigate gastric wall infiltration length of gastric cancer.A total of 105 patients with gastric cancer who underwent gastrectomy at Cancer Center of Sun Yat-sen University from Apr. 2002 to Feb. 2004 were eligible. During gastrectomy, gastric wall lengths of 18 patients before traction (L1), after traction (L2), and after isolation (L3) were measured. Longitudinal specimen along the center of gastric cancer was fixed to measure the lengths of proximal and distal margins to the cancer. Giant section was observed under microscope to calculate the true infiltration length in proximal and distal margins according to the principle of the length changing uniformity.In the 18 specimens, L2 was significantly longer than L1 and L3 (P0.05); no significant difference was showed between L1 and L3 (P0.05). The infiltration length of localized gastric cancer, including early stage cancer, Borrmann I type cancer, and Borrmann II type cancer, was less than 2 cmû that of invasive gastric cancer, including Borrmann III type cancer and Borrmann IV type cancer, was less than 5 cm.The resection length for localized gastric cancer is at least 2 cm to tumor margin, and for invasive gastric cancer is at least 5 cm to tumor margin.

Whether received radical operation is an important prognostic factor of gastric carcinoma. But the long-term efficacies of radical operation on different patients are not the same. This study was to investigate prognostic factors of gastric carcinoma.Clinical data of 405 patients with gastric carcinoma, received radical operation from Jan. 1985 to Dec. 1995 in Cancer Center of Sun Yat-sen University, were analyzed retrospectively. Life table method was used to analyze survival rate, Wilcoxon test was used for statistical comparison, and Cox regression model was used for multivariate analysis.The 5-year overall survival rate was 43.4%. The 5-year survival rates of patients in pathologic TNM (pTNM) stage I, II, III, and IV were 75.6%, 58.7%, 28.0%, and 18.4%, respectively (P0.01). The 5- year survival rates of patients with tumor sizes of less than 2.0 cm, 2.0-3.9 cm, 4.0-5.9 cm, 6.0-7.9 cm, and no less than 8.0 cm were 82.0%, 57.4%, 43.7%, 38.7%, and 26.9%, respectively (P0.05). In addition, the 5-year survival rate was higher in patients with perioperative chemotherapy than in patients without perioperative chemotherapy (47.2% vs. 37.8%, P0.05). Univariate analysis showed that perioperative chemotherapy, Borrmann type, tumor size, pathologic type, and pTNM stage were prognostic factors of gastric carcinoma. Multivariate analysis showed that pTNM stage, tumor size, and perioperative chemotherapy were independent prognostic factors of gastric carcinoma.pTNM stage, tumor size, and perioperative chemotherapy are the most significant factors influencing prognosis of gastric carcinoma patients after radical operation. Perioperative chemotherapy contributes to enhance survival rate of gastric carcinoma patients.

Gastric cancer has the highest incidence rate and mortality rate among gastrointestinal malignancies. Twenty percent of the patients with dissectable gastric cancer cannot be cured simply by surgery due to local infiltration and distant metastasis. To evaluate the therapeutic effectiveness and safety of oxaliplatin combined with 5-fluorouracil and leucovorin on the patients with gastric carcinoma after palliative gastric resection, we analyzed all of the cases of gastric adenocarcinoma undergone palliative gastric resection in our Cancer Center in recent years.A total of 41 patients who underwent palliative gastric resection from Jan. 2000 to May 2004 in our Cancer Center were evaluated. Chemotherapy was given 8-18 days post-surgically with oxaliplatin (130 mg/m(2), intravenus infusion) on day 1, leukovorin (200 mg/m(2)) on day 1, 5-FU (500 mg/m(2), infusion) on day 1 followed by (5-FU 2600 mg/m(2), continuous infusion) for 48 h, the cycle was repeated every 4 weeks. Primary evaluation was performed after 3 cycles of chemotherapy. The chemotherapy was terminated in the patients without response to the treatment. In the patients with response to the treatment, the chemotherapy continued until 6-8 cycles for further analyses.None of the patients died from surgery or chemotherapy. Complete response occurred in 2 cases, partial response occurred in 19 cases, stable disease in 8 cases, and progressive disease in 12 cases. The total response rate was 52.5%. The 1-year, 2-year, and 3-year survival rates were 71%, 43%, and 32%, respectively. The side effects included neuropathy, nausea, vomiting, and myelosuppression. No grade 3 or 4 myelosuppression was observed.Palliative surgery in late stage gastric cancer followed by combination chemotherapy of oxaliplatin, 5-fluorouracil and leucovorin is a safe therapeutic modality with promising short-term effectiveness and mild side effects.

Tumor microvessel density (MDV)partly indicates tumor angiogenesis,and it is a hot topic in the study of oncology. However, the relationship between tumor MVD and the clinicopathological characteristics of rectal cancer are unclear. This study was to explore the correlation of tumor MVD to metastasis and recurrence of rectal cancer.Records of 97 rectal cancer patients who had undergone radical resection in the Department of Abdominal Surgery, Cancer Center,Sun Yat-sen University from 1996 to 1997 were retrospectively analyzed. The paraffin-embedded tissues of resected tumor and para-tumor tissues were collected,microvessels were detected by immunohistochemistry using mouse anti-human CD31 antibody. The MVD was then calculated microscopically, its relations with clinicopathological parameters were analyzed with software package of SPSS 9.0.The values of MVD in tumor tissues,and non-cancerous para-tumor mucosa were 45.26+/-19.52,and 11.82+/-3.48 per high magnification field (x400)(P0.001). The MVD in the treatment-failed patients (recurrence and/or metastasis) was 62.72+/-21.75, while it was 41.23+/-16.68 in the patients with disease-free survival, the difference was significant (P0.001).The tumors with higher MVD are more likely to relapse or metastasize after operation. Tumor tissue MVD can be used as a biological indicator for post-operative metastasis and recurrence in rectal cancer.