[The efficacy and safety of laparoscopic radical gastrectomy after neoadjuvant chemotherapy combined with immunotherapy and targeted therapy]

Objectives: To explore the efficacy and safety of laparoscopic radical gastrectomy after neoadjuvant chemotherapy combined with immunotherapy and targeted therapy in patients with gastric cancer. Methods: A retrospective analysis of clinical and pathological data of 20 patients with locally advanced gastric cancer (clinical TNM stage T3-4aN+M0) admitted to the Cancer Hospital, Chinese Academy of Medical Sciences from July 2021 to July 2023. All patients received 3 cycles of SOX (Oxaliplatin+S-1) regimen combined with immunotherapy (Trastuzumab) and targeted therapy (Apatinib) as neoadjuvant treatment followed by laparoscopic radical gastrectomy for gastric cancer. Surgical outcomes, postoperative pathological response, and postoperative recovery were observed. Quantitative data, except for age and operation time, were expressed using Median (range). Results: Among the 20 patients, there were 18 males and 2 females, aged 41 to 73 years [(60.6±9.7) years]. All 20 patients underwent laparoscopic surgical treatment after neoadjuvant therapy, with one patient undergoing laparoscopic conversion to open total gastrectomy with partial transverse colon resection due to tumor invasion into the transverse mesocolon. Eight patients underwent totally laparoscopic radical gastrectomy, all with Billroth Ⅱ+Braun anastomosis at the distal stomach. Eleven patients underwent laparoscopic-assisted radical gastrectomy, among which total gastrectomy with Roux-en-Y anastomosis was performed in ten cases, and proximal gastrectomy with esophagogastrostomy overlap anastomosis was performed in one case. The mean operation time for the 20 patients was (165.0±34.1) minutes; intraoperative blood loss was 80 (20-100) ml; and the number of lymph nodes retrieved was 68 (21-89). Postoperative pathological TNM staging revealed stage T0N0M0 in six cases, stage Ⅰ in two cases, stage Ⅱ in three cases, and stage Ⅲ in nine cases. Six patients (30.0%) achieved pathological complete response, and nine patients (45.0%) achieved significant pathological response. The median postoperative time to flatus was 4 (1-5) days; oral intake resumed after 3 (2-5) days; and the median length of hospital stay was 13 (6-19) days. One patient developed colonic anastomotic leakage with intra-abdominal infection, and one patient developed duodenal stump leakage with intra-abdominal infection, both classified as Clavien-Dindo grade 3A complications, and improved after treatment and discharged. One patient developed gastric paresis, and two patients developed pleural effusion, classified as Clavien-Dindo grade 2 complications, and improved after treatment and discharged. There were no deaths within 30 days after discharge. Conclusions: Laparoscopic radical gastrectomy for gastric cancer after neoadjuvant treatment with the SOX regimen combined with immunotherapy and targeted therapy is safe and feasible, with satisfactory short-term efficacy. However, there is an increase in overall surgical risk and difficulty, and it is recommended to be performed in experienced gastric cancer centers.

[Design of an improved percutaneous transhepatic cholangio drainage tube based on MRCP imaging data]

Objective: Quantified MRCP imaging data was used as a reference for design and preparation of a modified percutaneous transhepatic cholangio drainage (PTCD) tube. Methods: 3.0 T upper abdominal MR and MRCP imaging data of 2 300 patients treated from July 2015 to July 2020 at the Department of Radiology of the Affiliated Cancer Hospital of Zhengzhou University were screened and a total of 381 patients diagnosed with biliary duct structures were identified. Causative etiologies among these patients included pancreatic adenocarcinoma (pancreatic head), cholangiocarcinoma, ampullary carcinoma, as well as intrahepatic and/or extrahepatic bile duct dilation. An improved PTCD tube was designed based on MRCP quantification of left and right hepatic and common hepatic duct length. Results: In the setting of biliary obstruction caused by malignancy, the distance of the left hepatic duct from its origin to the point of left and right hepatic duct confluence was 15.9±3.8 mm, while the distance of the right hepatic duct from its origin to the point of left and right hepatic duct confluence was 12.4±3.2 mm; the length of the bile duct from its origin to the point of left and right hepatic duct confluence was 34.0±8.1 mm. The improved PTCD tube design incorporated an altered length of the drainage orifice. Conclusion: MRCP imaging of the biliary tract is effective for measuring biliary tract length in the setting of pathological dilation. Based on our biliary tract measurements, a modified PTCD tube was designed to more effectively meet drainage requirements and manage biliary obstruction caused by Bismuth-Corlette type Ⅱ and Ⅲ malignancies.

[Surgical treatment strategy for digestive system malignancies during the outbreak of COVID-19]

The outbreak of COVID-19 occurred in Wuhan, Hubei province of China, at the end of 2019, and spread rapidly across the country. After the outbreak of this disease, the overwhelming majority of cities have launched the "first level response" and the regular diagnosis and treatment of cancer patients are greatly affected. The digestive systemic cancer is the most common malignancy. Most patients are diagnosed in the advanced stage with poor prognosis. The epidemic of COVID-19 poses new challenges to diagnosis and treatment of the patients with digestive system malignancies. Based on the fully understanding of the characteristics of digestive system tumors, we should change the treatment strategy and adopt more reasonable treatment strategy timely during the epidemic period to minimize the adverse effects of the epidemic of COVID-19 on the treatment.

[Characteristics of neuromyelitis optica spectrum disorder associated with the area postrema]

Objective: To evaluate the clinical characteristics and the corresponding MRI and laboratory findings in patients with neuromyelitis optica spectrum disorder (NMOSD) associated with area postrema (AP). Methods: The study was a retrospective analysis of data from 120 NMOSD patients, and 18 cases were with AP out of these patients, The clinical presentation, MRI changes, serological markers and treatment outcome were reported. Results: AP occurred in 18 patients (15%, 18/120). AP was the onset symptom in 14 (14/18) patients and 3 days to 7 months (median 40 days) later, optic neuritis or myelitis was involved. One patient presented AP after optic neuritis. Three patients (3/18) had AP and myelitis or optic neuritis simultaneously. AP symptom presented as intractable nausea and vomiting, hiccups. Compared to the patients without AP (n=102), the patients with AP (n=18) had shorter duration and fewer numbers of optic neuritis(P<0.05). There was no statistical difference in sex, onset age, course of disease (relapsing or monophasic) and EDSS scores (P>0.05). The MRI revealed flake or linear lesions in medulla. Twelve patients had cervical cord lesions extending to medulla lesions (12/18). Eleven patients had long cord lesions extending more than 3 spinal cords. The AQP4-antibody did not differ in patients with or without AP (14/18 vs 75/102). The symptom of AP was successfully relieved with methylprednisolone. Conclusion: AP symptoms/signs are common in patients with NMOSD. Vomiting and hiccups can be the first symptoms. The medulla lesions and the lesions extending to upper cervical cord are unique to NMOSD. Awareness of AP presentations is helpful for early diagnosis and proper treatment to prevent further disability.

[Value of split hand in the differential diagnosis of amyotrophic lateral sclerosis and cervical spondylotic amyotrophy]

Objective: To investigate the value of split hand in the differential diagnosis of amyotrophic lateral sclerosis(ALS) and cervical spondylotic amyotrophy (CSA). Methods: A total of 62 ALS patients, 57 CSA patients and 65 normal controls who visited the Neurology and Spine Department of Beijing Jishuitan Hospital from May 2013 to June 2017 were enrolled into this study.The amplitudes of compound muscle action potentials (CMAP) were recorded from abductor digiti minimi (ADM) and abductor pollicis brevis (APB). Moreover, the ratio of CMAP amplitude between ADM and APB (ADM/APB) was calculated. Results: The ADM/APB of the ALS group (1.93±1.97)was significantly higher than that of the normal control group (0.92±0.22)(P<0.05); the ADM/APB of the CSA group (0.74±0.32)was significantly lower than that of the normal control group (0.92±0.22)(P<0.05); the ADM/APB of the ALS group (1.93±1.97)was significantly higher than that of the CSA group(0.74±0.32)(P<0.05); the areas under receiver operator characteristic curve in patients with ALS was 0.843, the diagnostic sensitivity and specificity for ALS were 75.8% and 83.1% with the cutoff value of ADM/APB=1.077; the areas under receiver operator characteristic curve in patients with CSA was 0.737, the diagnostic sensitivity and specificity for CSA were 64.9% and 87.1% with the cutoff value of ADM/APB=0.739. Conclusion: The ADM/APB has certain clinical value for the differentiation of ALS and CSA.

[Human DNA polymorphism of HaeIII system in Chinese oriental, Han population]

DNA typing by restriction fragment length polymorphism (RFLP) analysis was an extremely important technique used in forensic science identification, paternity test and gene diagnosis. While RFLP testing was a highly informative method, it traditionally had several disadvantages. It was time consuming and involved in working with radioactive phosphorus. A chemiluminescent detection of RFLP technique that was faster and safer than isotopic detection. The chemiluminescent system had a good sensitivity of detecting 3-25 ng sample DNA. The development of direct alkaline phosphatase (AP) conjugated probes and improved chemiluminescent substrates provided a non-isotopic detection method that equaled or surpassed 32P detection systems. Population genetic studies were performed using direct alkaline phosphatase (AP) conjugated oligonucleotide probes (AL1874, YNH24, TBQ7, VI) that recognized four hypervariable number of tandem repeats regions (D2S92, D2S44, D10S28, D17S79 loci) respectively in the human genome. DNA from approximately 480 unrelated individuals, subdivided into oriental group were digested with HaeIII enzyme and were successively hybridized to each DNA probe. The number of distinct DNA fragments identified for each of these regions varies from 37 to more than 78. An allele frequency distribution was determined for each locus with the computer and digitizer. The results showed significant differences between different races (American-blacks, Caucasians, and Orientals), in the pattern of distributions as well as in the relative frequency of the most common alleles of D2S92, D2S44, D10S28, and D17S79. The results showed that the analysis of these loci had useful applications in genetics and in forensic identity.

[HLA-DRB alleles polymorphism in Han, Hui, Uygur and Tibetan populations in northwestern China]

According to the 11th THW standard, we designed a pair of primers by which a segment of 256bp of HLA-DRB1, B3, B4, and B5 could be amplified simultaneously. Twenty-seven oligonucleotide probes were designed and synthesized for 39 loci on DRB1, 3 on DRB3, 1 on DRB4 and 3 on DRB5. A PCR-SSO DNA typing protocol was built, which met the standard of HLA class II DNA typing in 11th IHW. With this method, 186 of Chinese (Han) in Xi'an, 169 of Hui in Ningxia, 200 of Uygur in Xinjiang, and 188 of Tibetan in Tibet were detected with a comparison study. The genetic distribution of 46 loci of DRB in four ethnic healthy populations were surveyed. No diversity has been found between Han and Hui in DRB. DRB1 * 02(16.9%), DRB1 * 07 (13.1%), and DRB1 * 09(12.0%) were the higher frequent loci in Han. More DRB loci were detected in Tibetan but without higher loci as in Han and Hui. The DRB polymorphism of Uygur population was similar to Caucasian. A discriminative highest frequency of DRB1 * 07(23.8%) was found in Uygur, which implied a selection happened.

Prenatal and molecular diagnosis of hemophilia B

Prenatal diagnosis was carried out on a woman who had previously given birth to a son with a spontaneous mutation of C-->T transition at nt 31133 of the factor IX (F.IX) gene. The diagnosis was performed on chorionic villi sampling by the method of amplification-created restriction site (ACRS). It revealed a female fetus with a normal F.IX gene, as confirmed by DNA sequencing after delivery. Meanwhile, a survey using the ACRS method to evaluate the inheritance of 63 individuals from 8 hemophilia B families was done. A different single-point mutation in each family was proved by DNA sequencing. One individual had a mutation with a naturally-created restriction site. In each of the remaining patients, we were able to show an enzyme-cutting site in their DNA amplification product for ACRS with the designed mutagenesis primers. All patients and carriers could be diagnosed accurately by comparing ACRS results with clinical and laboratory findings. There were new novel mutations among the patients.

Speech synthesis by glottal excited linear prediction

This paper describes a linear predictive (LP) speech synthesis procedure that resynthesizes speech using a 6th-order polynomial waveform to model the glottal excitation. The coefficients of the polynomial model form a vector that represents the glottal excitation waveform for one pitch period. A glottal excitation code book with 32 entries for voiced excitation is designed and trained using two sentences spoken by different speakers. The purpose for using this approach is to demonstrate that quantization of the glottal excitation waveform does not significantly degrade the quality of speech synthesized with a glottal excitation linear predictive (GELP) synthesizer. This implementation of the LP synthesizer is patterned after both a pitch-excited LP speech synthesizer and a code excited linear predictive (CELP) speech coder. In addition to the glottal excitation codebook, we use a stochastic codebook with 256 entries for unvoiced noise excitation. Analysis techniques are described for constructing both codebooks. The GELP synthesizer, which resynthesizes speech with high quality, provides the speech scientist a simple speech synthesis procedure that uses established analysis techniques, that is able to reproduce all speed sounds, and yet also has an excitation model waveform that is related to the derivative of the glottal flow and the integral of the residue. It is conjectured that the glottal excitation codebook approach could provide a mechanism for quantitatively comparing the differences in glottal excitation codebooks for male and female speakers and for speakers with vocal disorders and for speakers with different voice types such as breathy and vocal fry voices. Conceivably, one could also convert the voice of a speaker with one voice type, e.g., breathy, to the voice of a speaker with another voice type, e.g., vocal fry, by synthesizing speech using the vocal tract LP parameters for the speaker with the breathy voice excited by the glottal excitation codebook trained for vocal fry.

Isolated extramedullary relapse of acute lymphoblastic leukemia presenting as an intraspinal mass

Leptomeningeal relapse is a common finding in acute lymphoblastic leukemia (ALL), but a solid intraspinal mass with cord compression as the sole site of extramedullary relapse is unusual. We report an adult patient with ALL, after 2 years of complete remission, who developed a spinal cord compression due to an intraspinal mass as a first manifestation of extramedullary relapse. Manifestation of first relapse in ALL presenting as an intraspinal mass is rare and may be added to other unusual extramedullary sites of relapse.

DAE (daunorubicin, Ara-C, and etoposide) and intermediate dose Ara-C for remission induction and consolidation treatment of adult patients with acute myeloid leukemia

Fifty-one patients (age 18-73 years) with acute myeloid leukemia were treated with daunorubicin, cytarabine, and etoposide in an age-adjusted protocol, with patients older than 50 receiving fewer days of therapy. Complete remission (CR) occurred in 66% of the patients (34 of 51 patients). Patients 50 years of age and younger achieved a 74% CR rate (23 of 31 patients) compared to a 55% CR rate (11 of 20 patients) in older patients. Of the 34 complete responders, 11 (32%) refused consolidation therapy and received traditional Chinese herbal medicine. All of these 11 patients relapsed after a short remission duration (median, 3.8 months) and died. The median remission duration and median overall survival of 23 complete responders receiving at least two courses of consolidation therapy were 10.1 and 19.8 months, respectively. The actuarial 3-year disease-free survival for these 23 complete responders was 21 +/- 9%. Myelosuppression was the major toxicity, and nonhematological side effects were acceptable. The regimen appeared to have acceptable toxicity, and its efficacy was comparable with that of standard regimens with long-term maintenance therapy.

[Effects of castration and testosterone-replacement on hypothalamic and plasma luteinizing hormone-releasing hormone levels in the aged male rat]

Hypothalamic and plasma luteinizing hormone-releasing hormone (LHRH) levels following orchidectomy (ORDX) and testosterone (T)-replacement were compared between young (2-3 months old) and aged (24-26 months old) male rats by radioimmunoassay. Plasma T level and hypothalamic LHRH content are markedly decreased in the aged rat as compared to those of the young rat, whereas plasma LHRH levels are similar in the two groups. Following ORDX and ORDX plus T-replacement, plasma T levels in both groups are about the same, whereas the rates of variation of hypothalamic and plasma LHRH levels in the aged rat are significantly lower than those in the young rat. These results suggest that the negative feedback mechanism of the hypothalamic LHRHergic system is impaired in the aged rat, which may be one of the important reasons causing age-dependent deterioration of the functional control of hypothalamic-pituitary-testicular axis.

[Glomus tumor--clinical experience of 14 cases]

Fourteen cases of subungual glomus tumors were treated from June 1, 1984 to November 15, 1987. Of these cases, 4 were male and 10 were female; 8 occurred on the; right hand and 6 on the left hand; tumors found on the thumb: 6 case; on the index: 1 case; on the middle finger: 1 case, and on the ring finger: 6 cases. All these tumors were subungual, located around the lunula area and were treated by surgical excision with complete relief of symptoms. In the earlier cases, the tumors were approached with total nail removal and longitudinal incision in the nail bed. After the tumors were excised, the nail beds were repaired with 5 "0" or 6 "0" absorbable suture material. Longitudinal ridge deformities of the nail were noted in all these cases in the follow-up. In the later cases, the tumors were approached with proximal half nail removal and a "U" or "+" incision in the nail bed. After the tumors were excised, the nail beds were repaired with 7 "0" or 8 "0" suture material. No deformities of the nail were noted in these cases in the follow up. We suggest the subungual tumor be treated by surgical excision, and to avoid later nail deformity, the tumor located around the lunula be approached by proximal half nail removal, a "U" or "+" incision on the nail bed and repair of the nail bed with 7 "0" or 8 "0" suture material.

[Treatment of elbow contracture]

The most common sequela of the elbow joint after injury is decreased range of motion, i.e. elbow contracture. From January 1986 to July 1987, the Orthopaedic department of Kaohsiung Medical College collected data of 10 elbow contracture on 9 cases. Treatment included capsulotomy and joint debridement with immediate postoperative rehabilitation. This paper reports the clinical follow up results with an average time of 7 months after the operation. Range of motion increased 50 degrees on the average. No residual pain was complained. Activity of daily living was improved and the results were satisfied.