Robot-assisted versus laparoscopic-assisted gastrectomy among malnourished patients with gastric cancer based on textbook outcome

BACKGROUND

Textbook outcome (TO) has been widely employed as a comprehensive indicator to assess the short-term prognosis of patients with cancer. Preoperative malnutrition is a potential risk factor for adverse surgical outcomes in patients with gastric cancer (GC). This study aimed to compare the TO between robotic-assisted gastrectomy (RAG) and laparoscopic-assisted gastrectomy (LAG) in malnourished patients with GC.

METHODS

According to the diagnostic consensus of malnutrition proposed by Global Leadership Initiative on Malnutrition (GLIM) and Nutrition Risk Index (NRI), 895 malnourished patients with GC who underwent RAG (n = 115) or LAG (n = 780) at a tertiary referral hospital between January 2016 and May 2021 were included in the propensity score matching (PSM, 1:2) analysis.

RESULTS

After PSM, no significant differences in clinicopathological characteristics were observed between the RAG (n = 97) and LAG (n = 194) groups. The RAG group had significantly higher operative time and lymph nodes harvested, as well as significantly lower blood loss and hospital stay time compared to the LAG group. More patients in the RAG achieved TO. Logistic regression analysis revealed that RAG was an independent protective factor for achieving TO. There were more adjuvant chemotherapy (AC) cycles in the RAG group than in the LAG group. After one year of surgery, a higher percentage of patients (36.7% vs. 22.8%; P < 0.05) in the RAG group recovered from malnutrition compared to the LAG group.

CONCLUSIONS

For malnourished patients with GC, RAG performed by experienced surgeons can achieved a higher rate of TO than those of LAG, which directly contributed to better AC compliance and a faster restoration of nutritional status.

Synthesis of hierarchical pure ZnO nanostructures with controllable morphology

Hierarchical pure ZnO nanostructures with controllable morphology were synthesized by two-step oxygen-controlled thermal evaporation method without any catalyst. Zn nanowires with little oxidation were deposited firstly on Si substrates located at the low temperature area at step one. The morphology of hierarchical ZnO nanostructures can be effectively modulated at step two by oxygen flow rate, taking advantage of the controllable oxidation rate of Zn and concentration of ZnO(x) under various oxygen supplies. Transmission electron microscope images and corresponding selected area electron diffraction patterns suggest that low oxygen supplementation causes the epitaxial growth of nanorods from the surface of the Zn nanowire, while high oxygen flow rate will lead to the preferential growth of nanorods along the [001] orientation. Room-temperature photoluminescence measurements demonstrate that the variety of nanostructures can cause the variation of the ultraviolet to green peak intensity ratio, suggesting that the controlled morphologies can be used to modulate the optical properties of ZnO nanostructures.

Chemical conversion synthesis and optical properties of metal sulfide hollow microspheres

A facile chemical conversion method has been demonstrated to prepare various metal sulfide hollow microspheres. The present strategy utilizes the large difference in solubility between ZnS and other metal sulfides (Ag2S, PbS, CuS, Cu2S, Bi2S3, and Sb2S3) for the effective transformation and shows mild growth conditions and good reproducibility. The morphology, structure, and composition of the yielded hollow nanostructures have been confirmed by transmission electron microscopy, energy-dispersive X-ray analysis, and X-ray diffraction measurements. The optical properties of the metal sulfide hollow microspheres have been systematically investigated by absorption, micro-Raman, and photoluminescence spectroscopy. The results demonstrate that these metal sulfide hollow microspheres possess good optical quality with tunable band gaps and luminescence properties, which indicate their broad potential applications. This simple chemical conversion technique can be further extended to the synthesis of other semiconductors with various morphologies.

Significance of the straight-leg-raising test in the diagnosis and clinical evaluation of lower lumbar intervertebral-disc protrusion

The cases of 113 patients who had protrusion of a lumbar intervertebral disc were analyzed to determine the relationship between the findings at operation and the location of the pain that resulted from the straight-leg-raising test. The study showed a close relationship between the location of the pain and the position of the protrusion of the disc. The degree of limitation of straight-leg raising was also found to have a direct relationship to the size and position of the protrusion and to its relationship to the spinal nerve. The protrusions were classified into three types according to position in relation to the dura mater and to the pattern of pain that was induced by passive straight-leg raising. On straight-leg raising, central protrusions tended to cause pain in the back, lateral protrusions caused pain in the lower extremity, and intermediate protrusions caused both. On this basis, the distribution of pain on straight-leg raising allowed an accurate prediction of the location of the lesion in 100 (88.5 per cent) of the 113 patients.