Abstract Wound healing represents a well‐coordinated and sophisticated biological process characterized by the need for precise regulation and spatiotemporal synergy of multiple cells, regulatory cytokines, and signaling pathways, ultimately achieving repair and functional reconstruction of damaged tissues. In complex situations such as war, disasters and diseases, how to carry out wound management in a truly effective manner still stands as a notable challenge. The microenvironment of wound is multi‐dimensional, dynamic and complex, the wound healing process is collectively regulated by endogenous biochemical signals and exogenous physical, chemical, biological factors, which makes traditional dressings often fall short of expectations in the wound healing. Stimuli‐responsive hydrogels, by sensing endogenous factors (like pH, reactive oxygen species, and glucose, along with specific enzymes) or exogenous factors (light, temperature, electric fields, etc.), exhibit various intelligent characteristics, such as interacting with wounds, monitoring wound conditions or microenvironment changes, achieving precise drug release control or dynamic assessment of the wound healing process, thereby effectively promoting wound healing. Stimuli‐responsive hydrogel tissue engineering strategies (scaffolds, nanofibers, microneedles, microspheres, etc.) also provide more options for wound repair. Serving as a critical overview of stimuli‐responsive hydrogels, this review delves into the recent application scenarios of these hydrogels in wound management, systematically summarizes the attendant challenges, and seeks to offer a useful reference for studies in this research field.

Background:Laparoscopic gastrectomy is technically demanding and errors often arise from limited situational awareness. Artificial intelligence (AI)-based computer vision may enhance intraoperative recognition of instruments and anatomy, but evidence for generalizable, real-time deployment remains limited. Methods:We conducted a multicenter study using laparoscopic gastrectomy videos from 4 tertiary hospitals. Data were split by institution into training, internal test, and external validation sets. A You Only Look Once version 10 (YOLOv10)-based model was developed to recognize 18 categories (11 instruments and 7 organs) and integrated into a lightweight user interface for bedside use. Mean average precision at Intersection over Union (IoU) 0.50 (mAP@50) and AP@[0.50-0.95] for boxes and masks, recall, and F1 score were calculated. The feasibility of live operating-room deployment was assessed. Surgeon cognitive workload was assessed using the National Aeronautics and Space Administration Task Load Index (NASA-TLX), and system usability was evaluated with the System Usability Scale (SUS). Results:The training set comprised 4308 frames (41,066 labels); the internal testing set, 1803 frames (17,211 labels); and the external validation set, 721 frames (6685 labels). Training performance reached box precision 0.896, recall 0.891, mAP@50 0.937, and AP@[0.50-0.95] 0.846; mask AP@[0.50-0.95] was 0.809. On the internal testing set, box AP@[0.50-0.95] was 0.670 and mask AP@[0.50-0.95] 0.642. External validation achieved box precision 0.798, recall 0.773, F1 score 0.785, mAP@50 0.832, and AP@[0.50-0.95] 0.684; mask mAP@50 was 0.836 and AP@[0.50-0.95] 0.658. High-performing classes included stapler, ultrasonic scalpel, and forceps, whereas omentum and pancreas were relatively lower. The system operated in real time during laparoscopic gastrectomy on a laptop-grade GPU, providing on-demand overlays without workflow disruption. The NASA-TLX score was 26.72±6.51, indicating low cognitive burden, and the SUS score was 78.33±5.20, demonstrating good usability. Conclusions:We present development, external validation, and live deployment of a real-time AI navigation system for laparoscopic gastrectomy across multiple centers. The model demonstrated robust detection and segmentation of instruments and organs and was feasible for bedside use. Prospective trials are warranted to evaluate effects on intraoperative safety, efficiency, and training.

Colorectal cancer (CRC) is a prevalent malignancy worldwide, posing a significant public health concern. Mounting evidence has confirmed that timely early screening facilitates the detection of incipient CRC, thereby enhancing patient prognosis. Obviously, non-participation of asymptomatic individuals in screening programs hampers early diagnosis and may adversely affect long-term outcomes for CRC patients. In this letter, we provide a comprehensive overview of the current status of early screening practices, while also thoroughly examine the dilemmas and potential solutions associated with early screening for CRC. In response to these issues, we proffer a set of recommendations directed at governmental authorities and the general public, which focus on augmenting financial investment, establishing standardized screening protocols, advancing technological capabilities, and bolstering public awareness campaigns. The importance of collaborative efforts from various stakeholders cannot be overstated in the quest to enhance early detection rates and alleviate the societal burden of CRC.

BACKGROUND AND OBJECTIVES:Patients with gastrointestinal (GI) malignancies are at high risk for malnutrition because of reduced food intake, poor digestion, and altered absorption. METHODS AND STUDY DESIGN:In a ret-rospective review of medical records for patients admitted to urban hospitals in an Asian nation for GI tumor surgery (gastric, colon, or anorectal cancers), we found that malnutrition was common yet often overlooked. Our review identified records for 349 adult GI-tumor surgery patients. The Nutrition Risk Screening-2002 (NRS-2002) was the most frequently used screening instrument. In further review, we compared outcomes for malnourished GI tumor surgery patients given daily oral nutritional supplements (ONS) to outcomes for patients who were not given ONS. RESULTS:Review of results revealed that only 20% of patients in our sample underwent nutritional screening or assessment on admission. Of those who did, nearly 60% were malnourished. Although due to small sample sizes, no statistically significant differences were observed, mal-nourished patients who received ONS had fewer complications and shorter lengths of stay by 1-day. Such findings reveal many missed opportunities to improve patient outcomes and to avert excess healthcare costs for treatment of complications, slowed recovery, longer hospital stays, and readmissions. CONCLUSIONS:Based on our findings, nutritional training for professionals is necessary to address the serious problems of under-recognition and inadequate treatment of malnutrition in hospitalized patients.

Background:Currently, whether Gastric adenosquamous carcinoma (GASC) can benefit from perioperative chemoradiotherapy (pCRT) remains controversial. The objective of this study was to evaluate the survival benefit of pCRT in resectable GASC. Methods:Patients diagnosed with GASC were selected from the Surveillance, Epidemiology, and End Results (SEER) Program and our medical center. Enrolled patients were stratified into two cohorts according to whether they underwent perioperative chemotherapy and radiotherapy or not, and the overall survival (OS) and cancer-specific survival (CSS) of the two cohorts were compared. Subsequent subgroup analysis was performed to identify the population that could demonstrably benefit from chemoradiotherapy. Results:We screened almost 180,000 cases of gastric malignant neoplasms. Finally, only 267 patients with GASC met the inclusion criteria and were eventually included in the study, with 147 and 120 patients in the pCRT and non-pCRT groups, respectively. The baseline information of the two groups showed no statistically significant differences. Patients in the pCRT group had superior OS (26.0 vs. 13.0 months, p=0.002) and CSS (26.0 vs. 14.0 months, p=0.004). Univariate and multivariate COX regression analyses demonstrated that pCRT was an independent protective factor for favorable OS and CSS with in patients with GASC and age, race, tumor size, T stage, N stage and TNM stage were also independent predictors of survival. Subgroup analysis indicated that the GASC population aged ≤ 66 years, non-EGJ, tumor > 5 cm, tumor differentiation degree 3-4, T3-4 stage, N2-3, and TNM III-IV could significantly benefit from pCRT. The combined chemotherapy with radiotherapy group significantly improved OS and CSS of GASC compared to chemotherapy alone. Conclusions:This retrospective study verified that pCRT could improve the long-term OS and CSS of patients with GASC. Subgroup analysis found that patients with aged ≤ 66 years, tumor differentiation grade 3-4, T3-4, N2-3, and TNM III-IV could gain significant benefits from perioperative chemoradiotherapy. Moreover, the study demonstrated that patients with GASC receiving combined radiotherapy and chemotherapy had superior OS and CSS compared to those receiving chemotherapy alone, implying the crucial role of radiotherapy. This study provides an excellent evidence-based medical reference for GASC treatment.

BackgroundEducation, intelligence and cognition affect occupational performance and socioeconomic status and may influence virous diseases development. However, the impact of these factors on gastrointestinal diseases and their mediating risk factors remains unclear.MethodsWe utilized genome-wide association studies from European ancestry populations to perform two-sample Mendelian randomization analyses, aiming to estimate genetic instruments associated with education, intelligence, or cognition in relation to 24 gastrointestinal diseases Subsequently, we evaluated 14 potential mediators of this association and calculated the corresponding mediated proportions through two-step Mendelian randomization analyses.ResultAs the dominant factor in gastrointestinal diseases, education had a statistically significant association with 2 gastrointestinal diseases (acute pancreatitis, gastroesophageal reflux) and a suggestive association with 6 diseases (cirrhosis, alcoholic liver disease, cholecystitis, cholelithiasis, chronic gastritis and gastric ulcer). Of the 14 mediators, smoking and adiposity traits played a major role in mediating the effects.ConclusionThe study demonstrated the causal, independent impact of education on specific gastrointestinal diseases. Smoking and adiposity traits emerged as primary mediators, illuminating potential avenues for targeted interventions for prevention of them.

Abstract Background Whether adjuvant therapy has a survival benefit for all patients with T1N1M0 (Stage IB) gastric cancer (GC) remains controversial. This study attempted to confirm the value of adjuvant therapy in T1N1M0 GC patients with poorly differentiated and undifferentiated type. Methods Overall, 461 T1N1M0 GC patients with poorly differentiated and undifferentiated type following gastrectomy from 2004 to 2018 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score-matched (PSM) analysis was used to reduce bias. Overall survival was analyzed by Kaplan-Meier method and the log-rank test. Cox regression analyses were used to confirm the independent prognostic factors. Results Our study analyzed data from 461 patients in the Seer database who underwent postoperative treatment. Among them, 297 patients received adjuvant therapy. After PSM multivariate regression reveal that adjuvant therapy is associate with OS of the cohort (adjusted HR0.55; 95% CI: 0.38 ~ 0.77). The survival analysis presents that the 5-year OS was significantly higher in patients receiving chemotherapy (69.2% vs.51.5%, p < 0.001) and the 5-year CSS was higher in patients receiving chemotherapy (77.0% vs 61.1% p < 0.001). Conclusion In the population of patients with poorly differentiated and undifferentiated T1N1M0 gastric cancer, postoperative adjuvant therapy has shown potential survival benefits. However, further validation through randomized controlled trials (RCTs) is required to confirm this conclusion.

BACKGROUND:The current prognostic significance of perigastric tumor deposits (TDs) in gastric cancer (GC) remains unclear.AIM:To assess the prognostic value of perigastric TDs and put forward a new TNM staging framework involving TDs for primary GC.METHODS:This study retrospectively analyzed the pathological data of 6672 patients with GC who underwent gastrectomy or surgery for GC with other diseases from January 1, 2012 to December 31, 2017 at the Chinese PLA General Hospital. According to the presence of perigastric TDs or not, the patients were divided into TD-positive and TD-negative groups by using the method of propensity score matching. The differences between TD-positive and TD-negative patients were analyzed using binary logistic regression modeling. The Kaplan-Meier method was used to plot survival curves. Multivariate Cox regression modeling and the log-rank test were used to analyze the data.RESULTS:Perigastric TDs were found to be positive in 339 (5.09%) of the 6672 patients with GC, among whom 237 were men (69.91%) and 102 were women (30.09%) (2.32:1). The median age was 59 years (range, 27 to 78 years). Univariate and multivariate survival analyses indicated that TD-positive GC patients had a poorer prognosis than TD-negative patients (P < 0.05). The 1-, 3-, and 5-year overall survival rates of GC patients with TDs were 68.3%, 19.6%, and 11.2%, respectively, and these were significantly poorer than those without TDs of the same stages. There was significant variation in survival according to TD locations among the GC patients (P < 0.05). A new TNM staging framework for GC was formulated according to TD location. When TDs appear in the gastric body, the original stages T1, T2, and T3 are classified as T4a with the new framework, and the original stages T4a and T4b both are classified as T4b. When TDs appear in the lesser curvature, the previous stages N0, N1, N2, and N3 now both are classified as N3. When TDs appear in the greater curvature or the distant tissue, the patient should be categorized as having M1. With the new GC staging scheme including TDs, the survival curves of patients in the lower grade TNM stage with TDs were closer to those of patients in the higher grade TNM stage without TDs.CONCLUSION:TDs are a poor prognostic factor for patients with primary GC. The location of TDs is associated with the prognosis of patients with primary GC. Accordingly, we developed a new TNM staging framework involving TDs that is more appropriate for patients with primary GC.

BackgroundNatural killer (NK) cells play a major role in body's fighting against various types of cancers. Their infiltration in the tumor microenvironment (TME) of gastric cancer (GC) are significantly decreased, which has been reported as a robust prognostic marker. However, the causes leading to NK cells loss in GC TME remains poorly understood.MethodsWe constructed a non-contact co-culturing system and humanized xenograft tumor mice model to detect the influence of GC microenvironment on NK-92 or primary human NK cells viability by flow cytometry. Then through using the specific inhibitors for different types of cell death and examining the surrogate markers, we confirmed ferroptosis in NK cells. Inspired by the accidental discoveries, we constructed a NK-92 cell strain with high expression of GPX4 and treated the humanized xenograft tumor mice model with the NK-92 cells.ResultsWe found L-KYN, mainly generated through indoleamine 2, 3-dioxygenase (IDO) from GC cells, impaired NK cells viability in TME. Further analysis revealed L-KYN induced ferroptosis in NK cells via an AHR-independent way. Moreover, we found NK cells with higher GPX4 expression showed resistance to L-KYN induced ferroptosis. Based on this, we generated GPX4 over-expressed NK-92 cells, and found these cells showed therapeutic potential towards GC.ConclusionsOur study revealed a novel mechanism to explain the decline of NK cell number in GC TME. Notably, we also developed a potential immunotherapy strategy, which might be beneficial in clinical treatment in the future.

To date, Siewert type II adenocarcinoma of the esophagogastric junction (ST-II AEG) can be removed radically utilizing either the abdominal-transhiatal (TH) or the right thoracoabdominal (RTA) approaches. Because of a paucity of high-quality direct evidence, the appropriate surgical approach for ST-II AEG remains debatable. In the present, only several retrospective studies are available, representing ambiguous results. Thus, prospective randomized clinical trials are demanded to compare the survival, oncological outcomes, safety and efficiency and life quality between the TH and RTA approach in patients with resectable AEG of Siewert type II. A prospective, multicenter, open, randomized, and parallel controlled study named S2AEG will be conducted. Three hundred and twelve patients who match the inclusion criteria but not the exclusion criteria will be participating in the trial and randomly divided into the TH (156) and RTA (156) cohorts. The primary efficacy endpoint is the 3-year disease-free survival (DFS) following the operation. The rate of R0-resection, the number and site of lymph nodes infiltrated and dissected, postoperative complications, hospital days and life quality are the second endpoints. This study is the first prospectively randomized controlled trial aiming to compare the surgical outcomes between TH and RTA approaches in patients with resectable ST-II AEG. It is hypothesized that patients in the TH cohort would harvest equivalent oncological results and survival while maintaining acceptable life quality when compared to patients in the RTA cohort. Our findings will provide high-level clinical evidence for clinical decision-making on the appropriate surgical approach for patients with ST-II AEG. Embarked in November 2019, this research will be completed 3 years after the final participant’s enrolment date. Clinical Trial.gov ID: NCT04910789 May 29, 2021. Name: S2AEG.

BACKGROUND Three-dimensional (3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach (CRS), but its clinical efficacy remains controversial. AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy (3DLAG) with open gastrectomy (OG) for CRS. METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up, we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival (OS) rates were compared between the two groups. RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score, initial disease state (benign or malignant), primary surgical anastomosis method, interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss (188.33 +/- 191.35 mL vs 305.83 +/-; 303.66 mL; P = 0.045) and smaller incision (10.86 +/- 3.18 cm vs 20.06 +/- 5.17 cm; P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG (14.0 +/- 7.17 vs 10.73 +/- 6.82; P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups (1.56 +/- 2.84 vs 2.35 +/- 5.28; P = 0.413). The complication rate (8.3% vs 20.8%; P = 0.207) and intensive care unit admission rate (5.6% vs 14.5%; P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval (CI): 72.4%-95.6%] and 73.3% (95%CI: 60.0%-89.5%) respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3% (95%CI: 76.4%-99.8%) and 75.6% (95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups (P = 0.68). CONCLUSION Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.

The incidence of digestive system tumors has been increasing in recent years. Gastric cancer (GC) is one of leading causes of cancer-related mortality. Although a lot of research has been conducted, the effect of GC treatment is still not good. Pterostilbene (PT) has pro-apoptosis and anti-proliferation effects on solid tumors but the effect of PT on GC is unclear. Our study analyzed the effect of PT on GC and miR-126-3p, and provided a reliable reference for future clinical treatment of GC. Through Real time PCR, we first determined that miR-126-3p was down-regulated in GC, which is not related to general characteristics of patients, including gender and age, but is related to differentiation, metastasis, and tumor TNM pathological staging, suggesting that miR-126-3 could be used for predicting the occurrence and prognosis of cancer. In vitro experiments confirmed that further down-regulation of miR-126-3p can increase tumor cell proliferation, decrease apoptosis, promote invasion, and inhibit EMT. On the other hand, overexpression of miR-126-3p inhibited cancer cell-related activities, but promoted EMT. Administration of PT suppressed GC cell activity, inhibited EMT, and increased the expression of miR-126-3p, indicating that PT may affect GC cells by regulating miR-126-3p, which may be one of options for new treatments of GC in the future.

Gastric cancer (GC), a malignant tumor of digestive tract, is characterized by a high death rate. Thus, it is of particular importance to clarify the mechanisms of GC and gain new molecular targets for the sake of preventing and treating GC. It was reported that long non-coding RNAs (IncRNAs) are prognostic factors to cancer. Ferroptosis refers to a process of programmed cell death dependent on iron. This study sets out to investigate the expression and function of ferroptosis-related lncRNA (FRlncRNA) in GC. TCGA datasets offered RNA-seq data for 375 GC patients and clinical data for 443 GC patients. Based on Pearson's correlation analysis, we studied their expression and identified the FRlncRNAs. Differentially expressed prognosis related to FRlncRNA were determined with the help of the Wilcoxon test and univariate Cox regression analysis. To evaluate the accuracy of the prognostic capacity, researchers used the Kaplan-Meier technique, as well as univariate and multivariate Cox regression and receiver operating characteristic (ROC) curve studies. We also carried out the real-time PCR and CCK8 assays to examine the expression and function of FRlncRNA. In this study, we identified 50 ferroptosis-related DEGs which were involved in tumor progression. In addition, we identified 33 survival-related FRlncRNAs. Among them, lncRNA associated with SART3 regulation of splicing(LASTR) was confirmed to be highly expressed in GC specimens compared to non-tumor specimens in this cohort. Survival assays illuminated that the high LASTR expression predicted a shorter overall survival and progression-free survival of GC patients. Based on multivariate Cox regression analyses, it was confirmed that the GC had a worse chance of surviving the disease overall if their tumors expressed LASTR, which was an independent prognostic indication. Then, Loss-of-function tests showed that knocking down LASTR had a significant effect on reducing the proliferation of GC cells. Finally, we found that the expression of LASTR was negatively associated with CD8 T cells, T cells, Th17 cells, and T helper cells. Overall, our findings identified a novel survival-related FRlncRNA, LASTR which possibly can serve as a novel prognostic biomarker predicting response to cancer immunotherapy and therapeutic target for GC patients.

BACKGROUND:Platelet activating factor acetylhydrolase 1b catalytic subunit 3 (PAFAH1B3) is associated with a variety of human diseases. However, its function in gastric cancer remains uncertain.METHODS:PAFAH1B3 expression was analyzed in The Cancer Genome Atlas (TCGA) and genotype-tissue expression pan-cancer data. The association between PAFAH1B3 expression and patient prognosis was evaluated using TCGA clinical survival data. Enrichment analysis of PAFAH1B3 was performed using the clusterProfiler R software package. Moreover, the correlation between PAFAH1B3 expression and immune cell infiltration were evaluated by analyzing TCGA database. CCK8 assay and colony-formation assay were performed to assess the effect of PAFAH1B3 on the proliferation of gastric cancer cells. Transwell assay was used to evaluate the impact of PAFAH1B3 on gastric cancer cell migration. Western blot was performed to evaluate the role of PAFAH1B3 on signaling pathways in gastric cancer cells.RESULTS:PAFAH1B3 was highly expressed in many types of tumors including gastric cancer. High PAFAH1B3 expression was significantly correlated with proliferation-related gene sets involved in DNA replication, the cell cycle, and cell cycle checkpoints. Further analysis showed that high PAFAH1B3 expression was associated with high M1 macrophage and CD8-positive T cell infiltration scores. PAFAH1B3 knockdown inhibited the proliferation, migration, and the activation of oncogenic signaling in gastric cancer cells.CONCLUSIONS:Our findings suggest that PAFAH1B3 may be an oncogene in gastric cancer.

BACKGROUND The potential survival benefit of neoadjuvant chemotherapy (NC) in patients with advanced gastric cancer has been widely recognized. With the development of minimally invasive surgery, which is represented by laparoscopy, the effect of NC on the safety of laparoscopic gastrectomy remains to be further explored. AIM To compare the short-term outcomes of laparoscopic total gastrectomy (LTG) after NC (NC-LTG) with LTG alone. METHODS A total of 92 patients who underwent NC-LTG and 381 patients who received LTG alone at the Chinese PLA General Hospital between September 2015 and September 2020 were retrospectively included in our study. We used propensity-score matching (PSM) to balance baseline bias. After 1:1 PSM, 73 patients were included in each group with no statistically significant difference in baseline characteristics. RESULTS The NC-LTG group exhibited a longer operation time (244.10 ± 48.13 min vs 225.74 ± 45.33 min, P = 0.019) and increased intraoperative blood loss [150 (100-300) mL vs 100 (100-200) mL, P = 0.011] compared to the LTG group. The 30-d postoperative morbidity of the NC-LTG group was 20.5% (15/73), and that of the LTG group was 13.7% (10/73). There were no significant differences in 30-d severe complication rates or anastomotic leakage rates. Subgroup analysis showed that the patients with pTNM (pathological tumor-node-metastasis classification) T0N0-II in the NC-LTG group underwent a longer operation than the LTG group, while no significant difference was found in any perioperative index for the pTNM III patients. A multivariate analysis showed that an operation time longer than 240 min was an independent risk factor (odds ratio = 3.021, 95% confidence interval: 1.160-7.868, P = 0.024), while NC was not an independent risk factor for postoperative complications in LTG. CONCLUSION Despite a longer operation time and more blood loss after NC-LTG, which indicate surgical difficulty, NC-LTG exhibits acceptable short-term outcomes compared to LTG, suggesting the safety and feasibility of NC-LTG.

Objective:To compare the short-term efficacy of Billroth Ⅱ+Braun anasto-mosis versus Roux-en-Y anastomosis in totally three-dimensional (3D) laparoscopic distal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 140 patients with gastric cancer who were admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2020 were collected. There were 105 males and 35 females, aged from 23 to 84 years, with a median age of 55 years. Of the 140 patients, 54 patients undergoing totally 3D laparoscopic distal gastrectomy with Billroth Ⅱ+Braun anastomosis were allocated into Billroth Ⅱ+Braun group, and 86 patients undergoing totally 3D laparoscopic distal gastrectomy with Roux-en-Y anastomosis were allocated into Roux-en-Y group, respectively. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect remnant gastritis and its severity, bile reflux, reflux esophagitis in the postoperative 3 months up to April 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the Mann-Whitney U test. Results:(1) Surgical situations: 140 patients underwent totally 3D laparoscopic distal gastrectomy. The operation time, cases with volume of intraoperative blood loss <50 mL, 50 to 200 mL or >200 mL, the number of lymph node dissected were (233±39)minutes,15, 35, 4, 30±13 for the Billroth Ⅱ +Braun group , respectively, versus (240±52)minutes,25, 51, 10, 27±10 for the Roux-en-Y group, showing no significant difference between the two groups ( t=0.856， χ2=0.774， t=1.518， P>0.05). (2) Postoperative situations: cases with drainage tube, time to postoperative first flatus, cases with postoperative grade Ⅱ, Ⅲ, Ⅳ, Ⅴ complications, cases with postoperative complications, cases with postoperative severe complications, duration of postoperative hospital stay, surgery cost and total hospitalization cost of the Billroth Ⅱ+Braun group were 38, (3.5±0.8)days,4, 1, 0, 0, 5, 1, (9.0±5.0)days, (3.8±1.2)×10 4 yuan and (9.7±2.1)×10 4 yuan, respectively. The above indicators of the Roux-en-Y group were 59, (3.7±1.0)days, 9, 1, 0, 1, 11, 2, (9.0±4.0)days, (4.3±1.0)×10 4 yuan and (9.2±2.1)×10 4 yuan, respectively. There was a significant difference in the surgery cost between the two groups ( t=2.453, P<0.05), while there was no significant difference in cases with drainage tube, time to postoperative first flatus, cases with postoperative grade Ⅱ, Ⅲ, Ⅳ, Ⅴ complications, cases with postoperative complications, duration of postoperative hospital stay or total hospitalization cost between the two groups ( χ2=0.049, t=?1.339, Z=0.000, χ2=0.409, t=0.197, 1.383, P>0.05). There was also no significant difference in cases with postoperative severe complications between the two groups ( P>0.05).(3) Follow-up: 134 of 140 patients received the follow-up, including 52 cases in the Billroth Ⅱ+Braun group and 82 cases in the Roux-en-Y group. Results of follow-up within postoperative 3 months showed that the incidence rates of remnant gastritis, bile reflux, reflux esophagitis were 61.5%(32/52), 38.5%(20/52), 26.9%(14/52) for the Billroth Ⅱ+Braun group, respectively, versus 41.5%(34/82), 22.0%(18/82), 12.2%(10/82) for the Roux-en-Y group, showing significant differences between the two groups ( χ2=5.131, 4.270, 4.695, P<0.05). Cases with grade 0,Ⅰ,Ⅱ, Ⅲ, Ⅳ residual food were 42, 3, 5, 2,0 for the Billroth Ⅱ+Braun group, versus 67, 9, 1, 5,0 for the Roux-en-Y group, showing no significant difference between the two groups ( Z=?0.156, P>0.05). Cases with minimal lesion, grade A, grade B gastritis (severity of gastritis) were 6, 5, 3 for the Billroth Ⅱ+Braun group, versus 8, 2, 0 for the Roux-en-Y group, showing no significant difference between the two groups ( Z=?1.468, P>0.05). Conclusions:It is safe and feasible to operate Billroth Ⅱ+Braun or Roux-en-Y anastomosis in totally 3D laparoscopic distal gastrectomy. Billroth Ⅱ+Braun anastomosis can reduce the surgical cost. Roux-en-Y anastomosis has advantages in reducing the incidence of reflux esophagitis, bile reflux and reflux gastritis.

Introduction Laparoscopic distal gastrectomy (LDG) is regarded as a standard treatment for patients with clinical stage I–III gastric cancer. With the popularisation of the Da Vinci robotic system in the 21st century, robotic distal gastrectomy has been increasingly applied, and its potential advantages over LDG have been proved by several studies. Intraperitoneal anastomosis is a hot topic in research as it highlights the superiority of minimally invasive surgery and is safe and feasible. We intend to conduct this randomised clinical trial to focus on short-term outcomes and quality of life (QOL) in totally laparoscopic distal gastrectomy (TLDG) and totally robotic distal gastrectomy (TRDG) for patients with clinical stage I–III gastric cancer.Methods and analysis This study is a prospective, multi-institutional, open-label randomised clinical trial that will recruit 722 patients with a 1:1 ratio (361 patients in the TLDG group and 361 patients in the TRDG group) from eight large-scale gastrointestinal medical centres in China. The primary endpoint is 30-day postoperative morbidity. The secondary endpoints include QOL, 30-day severe postoperative morbidity and mortality, anastomotic-related complication rate, conversion to open surgery rate, intraoperative and postoperative indicators, operative and total costs during hospitalisation, 1-year overall survival and disease-free survival. QOL is determined by the The European Organization for Reasearch and Treatment of Cancer Quality of Life Questionnare-Core 30 and Stomach22 (EORTC QLQ-C30 and STO22) questionnaires which are completed before surgery and 1, 3, 6 months, and 1 year after surgery. χ2 test will be used for the primary endpoint, while analysis of covariance will be used to compare the overall changes of QOL between the two groups.Ethics and dissemination This trial was approved by the Ethics Committee of the Chinese PLA General Hospital. The trial’s results will be disseminated via peer-reviewed scientific journals and conference presentations.Trial registration number ChiCTR2000032670.

Background: The current model for predicting prognosis and chemotherapy response of patients with gastric adenocarcinoma is the TNM staging system, which may lack adequate accuracy and evaluations of molecular features at the individual level. We aimed to develop a prediction model to assess the individualized prognosis and responsiveness to fluorouracil-based adjuvant chemotherapy. Method: This retrospective study concluded 2 independent cohorts of patients with GAC. The expression of dysbindin was quantified and evaluated the association with the overall survival for GAC patients. A prediction model for postoperative overall survival was generated and internally and externally validated. The interaction between dysbindin expression and PACT was detected in advanced GAC patients. Results: Of the 637 patients enrolled in the study, 425 were men (66.7%) with a mean (SD) age of 59.79 (9.81) years. High levels of dysbindin expression predicted a poor prognosis in patients with GAC. Multivariate analysis demonstrated dysbindin expression was an independent prognostic predictor of overall survival in the test, validation and combined cohorts. A prognostic predictive model incorporating age, dysbindin expression, pathological differentiation, Lauren's classification and the TNM staging system was established. This model had better predictive accuracy for overall survival than the traditional TNM staging system and was internally and externally validated. More importantly, advanced GAC patients with low dysbindin expression were likely to benefit from fluorouracil-based PACT. Conclusion: The risk stratification model incorporating dysbindin expression and TNM staging system showed better predictive accuracy. Advanced GAC patients with low dysbindin expression revealed better response of fluorouracil-based adjuvant chemotherapy.

Objective:To analyze the short-term outcomes and factors influencing the postoperative complications of elder patients with gastric cancer under robotic gastrectomy.Methods:Clinical data of 167 elder patients undergoing robotic gastrectomy in the department of general surgery, Chinese PLA General Hospital First Medical Center between Apr. 2016 and Apr. 2021 were retrospectively analyzed. We used univariate and multivariate analysis to find the factors affecting the 30-days postoperative complications.Results:49 of 167 patients (29.3%) had Clavien-Dindo classification ≥ grade Ⅱ postoperative complications. 14 patients(8.4%) had Clavien-Dindo classification ≥ grade Ⅲa complications. Univariate analysis showed that vascular invasion, intraoperative blood loss ≥400 ml, NRS2002 score ≥3, BMI(body mass index)≥25 kg/m2 and aCCI(age-adjusted charlson comorbidity index)score≥4 were associated with the 30-day postoperative complications in elderly patients with gastric cancer under robotic gastrectomy (P< 0.05). Multivariate analysis showed that vascular invasion, intraoperative blood loss ≥400 ml, BMI≥25 kg/m2 and aCCI score≥4 were independent risk factors for 30-days postoperative complications in elderly patients with significant difference.Conclusions:Elderly patients who accepted robotic gastrectomy are safe and feasible. The independent risk factors for 30-days postoperative complications are vascular invasion, intraoperative blood loss ≥400 ml, BMI≥25 kg/m2 and aCCI score≥4. For patients with above risk factors, surgeons need to pay more attention to avoid complications by sufficient preoperative evaluation.

Objectives In Crohn's disease (CD), the mechanisms underlying the regulation by granulocyte-macrophage colony-stimulating factor (GM-CSF) of mucosal barrier function in the ileum are unclear. We analyzed the molecular mechanisms underlying the regulation by GM-CSF of the mucosal barrier function. Methods We examined the role of GM-CSF in the intestinal barrier function in CD at the molecular-, cellular-, and animal-model levels. Results Macrophages directly secreted GM-CSF, promoting intestinal epithelial proliferation and inhibiting apoptosis, which maintained intestinal barrier function. Macrophages were absent in NSAID-induced ileitis, causing GM-CSF deficiency, increasing the apoptosis rate, decreasing the proliferation rate, increasing inter- and paracellular permeabilities, decreasing the TJP levels, and reducing the numbers of mesenteric lymph nodes, memory T cells, and regulatory T cells in Csf1op/op transgenic mice. Conclusions GM-CSF is required for the maintenance of intestinal barrier function. Macrophages directly secrete GM-CSF, promoting intestinal epithelial proliferation and inhibiting apoptosis.