The occurrence and development of gastric cancer(GC)is determined by many factors.In recent years,the development of molecular biology has provided new ideas for the diagnosis and treatment of GC.Microsatellite instability(MSI)GC is a special type of GC caused by the body's DNA mismatch repair(MMR)gene defect.Studies of the clinical characteristics,molecular mechanisms and prognosis of MSI GC found specific clinicopathological features and better prognosis in MSI GC compared with ordinary types of GC.However,there are still some controversies in the study of MSI gastric cancer at home and abroad.This article aims to review the concept of MSI,the relationship between MSI and clinicopathological features of gastric cancer,and the treatment progress of MSI gastric cancer.

BACKGROUND:The fibrinogen to albumin ratio (FAR) is increasingly regarded as a potential biomarker for predicting prognosis in variety of malignant tumors, but not in gastric signet ring cell carcinoma (GSRC). This study seeks to examine the prognostic value of the FAR and explore a novel FAR-CA125 score (FCS) in resectable GSRC patients. METHODS:A retrospective cohort was conducted including 330 GSRC patients who underwent curative resection. Kaplan-Meier (K-M) and Cox regression were used to analysis the prognostic value of FAR and FCS. And a predictive nomogram model was developed. RESULTS:The optimal cut-off values for CA125 and FAR were 9.88 and 0.0697, respectively, according to the receiver operating characteristic curve (ROC). Th area under the ROC curve of FCS is higher than CA125 and FAR. 330 patients were grouped into three groups according to the FCS. High FCS was related to males, anemia, tumor size, TNM stage, lymph node metastasis, tumor invasion depth, SII, and pathological subtypes. K-M analysis showed that high FCS and FAR were associated with poor survival. In the multivariate analysis, FCS, TNM stage, and SII were independent prognostic factors for poor OS in resectable GSRC patients. And the predictive accuracy of clinical nomogram contained FCS was better than TNM stage. CONCLUSION:This study indicated that the FCS is a prognostic, and effective biomarker for patients with surgically resectable GSRC. Such developed FCS-based nomogram could be effective tools to assist the clinicians to determine the treatment strategy.

全内脏反位(situs inversus totalis,SIT)即所有内脏的位置都与正常人的相反[1] ,是一种非常罕见的先天性疾病,在正常人群中的患病率为 1/5000 ～ 1/20 000[2].尽管SIT与胃癌并没有明确的关系,但许多恶性肿瘤的发生可能与SIT相关[3] .

The survival rate and quality of life of patients with advanced gastric cancer are low. Despite the continuous development and improvement of chemotherapy regimens for advanced gastric cancer, the survival rate of patients with advanced gastric cancer is still low. At present, not only are comprehensive treatment methods very limited for advanced gastric cancer, but there is also a lack of posterior treatment methods. Therefore, there is an urgent need for effective treatment plans for advanced gastric cancer. In recent years, with the in-depth research on tumor immunology, immunotherapy has become a focus of attention. Programmed cell death protein-1 (PD-1) inhibitor, as an immunosuppressive drug, combined with chemotherapy, can not only maximize the clinical activity of immunosuppressive drug, but also establish a lasting immune response. At present, the combination of PD-1 inhibitors and platinum chemotherapy has shown high clinical application value in clinical research of advanced gastric cancer. This article reviews the research progress of PD-1 inhibitors combined with chemotherapy for advanced gastric cancer, aiming to provide a basis for clinical application.

贡物制度是指古代周边部族与国家在向中原王朝朝贡的过程中,朝贡使团遵循一定的礼仪与仪式向中原王朝贡献本地土特产的制度.具体到唐代,商品属性层面上,唐朝建立起对贡物核勘、运输、议价等方面的制度,确保各方利益不受损害.政治属性层面上,通过仪式上贡物的公开展示,羁縻府州及藩属国寻找到了 一条非武力、和平地进行国力较量的路径.文化属性层面上,依凭着贡物和赏赐的流通,各方实现了文化上的互联互通.贡物制度通过一系列规定保障了唐朝、羁縻府州及藩属国两方面的利益,客观上为营造一个和谐的东亚世界提供了助力.

胃癌是常见的消化系统恶性肿瘤,治疗方式以手术为主.随着医疗水平的进步,胃癌患者的生存率有所提高,术后并发症也引起人们的关注,临床实践发现一些胃癌患者术后会发生胆囊结石或胆囊炎,有的甚至需二次手术治疗,严重影响了患者的生活质量.目前对于胃癌术后术后胆囊结石形成的危险因素尚无统一定论,较为明确的危险因素包括神经因素、胃切除范围、消化道激素、消化道重建及淋巴结清扫范围等.同样对于胃癌术后胆囊结石的预防尚无统一定论,其中是否需要进行预防性的胆囊切除仍存在很大的争议,也是临床医生关注的焦点.本文就胃癌术后胆囊结石形成的危险因素以及目前最新的预防措施做一综述,希望能对临床工作有所帮助.

近年,国内外学者对胃癌的预后因素进行了广泛研究,其中以非特异性炎症免疫标志物在胃癌中的研究较为集中.对可切除性胃癌患者来说,肿瘤相关巨噬细胞和肿瘤浸润淋巴细胞是研究的热点.肿瘤组织内浸润的肿瘤相关巨噬细胞越多,预后越差,相反,肿瘤浸润淋巴细胞越多则预后越好.此外,中性粒细胞与淋巴细胞比值、系统性免疫炎症指数、预后营养指数,这些炎症和免疫指标对行可切除性胃癌手术患者的预后也具有指导意义.有研究以这些指标为基础,通过可视化的列线图,对可切除性胃癌患者建立了高效的术后预测模型.今后,除了探讨这些指标在胃癌患者围手术期的动态变化对预后的影响价值,还要建立更高效能的预测模型,精确的预测可切除性胃癌患者的预后.

Objective To explore the influence of negative lymph node count (NLNC) on the prognosis of patients with gastric signet ring cell carcinoma (GSRC) and develop a prognostic nomogram based on NLNC. Methods On the basis of the SEER database, 2 101 patients diagnosed with GSRC were collected and randomly divided into the modeling group and validation group to test the relationship between clinicopathological characteristics and the prognosis of GSRC. The multivariate Cox proportional hazard regression model was used to analyze the independent risk factors affecting overall survival and establish a prognostic prediction model. The consistency index (C-index), calibration curve, net reclassification index (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) were used to evaluate the accuracy and clinical applicability of the nomogram. Results All patients were divided according to the ratio of 7:3, with 1 473 in the modeling group and 628 in the validation group. NLNC > 10 (HR=0.578, 95%CI: 0.504-0.662, P < 0.001) was a protective factor for the prognosis of patients with GSRC, and the nomogram model was established based on multivariate Cox proportional hazards model. The C-index values of the nomogram were 0.737 (95%CI: 0.720-0.753) and 0.724 (95%CI: 0.699-0.749) in the modeling and validation groups, respectively, showing good discrimination. The calibration curves showed high consistency of the model. NRI=17.77%, continuous NRI=36.34%, and IDI=4.2% indicated that the model had positive returns compared with the traditional model. The DCA was far from the baseline, indicating that the model had good clinical applicability. Conclusion The increase in NLNC is a favorable factor for the prognosis of patients with GSRC, and a relatively accurate nomogram was established to predict the prognosis of patients with GSRC and help clinicians conduct individualized prognostic evaluations.

作为明清易代史的关键性人物之一,袁崇焕一直是学界关注的焦点.2006年,阎崇年以袁崇焕为核心人物,在中央电视台"百家讲坛"栏目开讲《明亡清兴六十年》,触发了新一轮"袁崇焕研究热".2020年,王荣湟博士新著《袁崇焕全传》(岳麓书社,以下简称《全传》)出版.全书共分八章,70余万字,并附有与辽东相关的督抚镇道官表和袁崇焕年谱.相较于以往研究,我认为《全传》有三个特色和一个突破.