It is unclear whether laparoscopic distal gastrectomy for locally advanced gastric cancer is oncologically equivalent to open distal gastrectomy. The noninferiority of laparoscopic subtotal ...gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer compared with open surgery in terms of 3-year relapse-free survival rate was evaluated.
A phase III, open-label, randomized controlled trial was conducted for patients with histologically proven locally advanced gastric adenocarcinoma suitable for distal subtotal gastrectomy. The primary end point was the 3-year relapse-free survival rate; the upper limit of the hazard ratio (HR) for noninferiority was 1.43 between the laparoscopic and open distal gastrectomy groups.
From November 2011 to April 2015, 1,050 patients were randomly assigned to laparoscopy (n = 524) or open surgery (n = 526). After exclusions, 492 patients underwent laparoscopic surgery and 482 underwent open surgery and were included in the analysis. The laparoscopy group, compared with the open surgery group, suffered fewer early complications (15.7%
23.4%, respectively;
= .0027) and late complications (4.7%
9.5%, respectively;
= .0038), particularly intestinal obstruction (2.0%
4.4%, respectively;
= .0447). The 3-year relapse-free survival rate was 80.3% (95% CI, 76.0% to 85.0%) for the laparoscopy group and 81.3% (95% CI, 77.0% to 85.0%; log-rank
= .726) for the open group. Cox regression analysis after stratification by the surgeon revealed an HR of 1.035 (95% CI, 0.762 to 1.406; log-rank
= .827;
for noninferiority = .039). When stratified by pathologic stage, the HR was 1.020 (95% CI, 0.751 to 1.385; log-rank
= .900;
for noninferiority = .030).
Laparoscopic distal gastrectomy with D2 lymphadenectomy was comparable to open surgery in terms of relapse-free survival for patients with locally advanced gastric cancer. Laparoscopic distal gastrectomy with D2 lymphadenectomy could be a potential standard treatment option for locally advanced gastric cancer.
Bare LiMn2O4 was coated by a thin Al2O3 layer using electrostatic attraction forces to investigate the effects of the Al2O3 coating on the high-temperature cyclic performance of LiMn2O4. Transmission ...electron microscopy (TEM) studies indicated that 5-nm thin and amorphous Al2O3 layer formed uniformly on the surface of 2wt.% Al2O3 coated LiMn2O4. The high-temperature cyclic performance of the LiMn2O4 was significantly improved by the coating. From the Electrochemical Impedance Spectroscopy (EIS) and X-ray Fluorescence (XRF) analysis, the coating reduced the charge transfer resistance and inhibited the Mn dissolution. The improved electrochemical performance of the Al2O3 coated LiMn2O4 was attributed to the decrease in the Mn dissolution by the coating.
Lithium metal batteries (LMB) are being extensively studied as next-generation batteries. However, low cyclability still hinders their application due to the high reactivity and dendrite growth of ...the lithium metal. Accordingly, designing a stable solid electrolyte interphase (SEI) to suppress side reactions and dendrite growth is crucial. Herein, we prepare cross-linked gel polymer electrolytes (GPEs) containing localized high-concentration electrolytes, which tune the Li+ solvation sheath to construct a robust, ion-conductive SEI on Li anode. The weak binding between Li cations and carbonyl groups in trimethylolpropane trimethacrylate used as a cross-linking agent enhances the coordination between Li cations and anions, promoting the formation of inorganic-rich SEI on the Li metal anode. The cell assembled with thin Li metal anode (20 μm), GPE, and LiNi0.8Co0.1Mn0.1O2 cathode (3.1 mAh cm−2) exhibits a superior capacity retention of 93.5 % after 200 cycles at 0.33C with a high energy density of 233.1 Wh kg−1. The enhanced cycling stability of the GPE-based cell is systematically compared to that of the liquid electrolyte cell. Our results provide new insights into the role of GPE in regulating the solvation sheath of Li+ cations and facilitating the formation of a stable SEI on the Li metal anode.
•GPE was synthesized using localized high-concentration electrolyte and TMPTMA.•It showed a high ionic conductivity of 6.0 mScm−1 and wide electrochemical stability.•GPE formed a stable Li + ion-conductive and inorganic-rich SEI on the Li metal anode.•The 20-μm Li/NCM811 cell with GPE exhibited good cycling performance at 25 °C.
With the demand for high-energy-storage devices, the rechargeable metal-oxygen battery has attracted attention recently. Sodium-oxygen batteries have been regarded as the most promising candidates ...because of their lower-charge overpotential compared with that of lithium-oxygen system. However, conflicting observations with different discharge products have inhibited the understanding of precise reactions in the battery. Here we demonstrate that the competition between the electrochemical and chemical reactions in sodium-oxygen batteries leads to the dissolution and ionization of sodium superoxide, liberating superoxide anion and triggering the formation of sodium peroxide dihydrate (Na2O2·2H2O). On the formation of Na2O2·2H2O, the charge overpotential of sodium-oxygen cells significantly increases. This verification addresses the origin of conflicting discharge products and overpotentials observed in sodium-oxygen systems. Our proposed model provides guidelines to help direct the reactions in sodium-oxygen batteries to achieve high efficiency and rechargeability.
Background
With improved short-term surgical outcomes, laparoscopic distal gastrectomy has rapidly gained popularity. However, the safety and feasibility of laparoscopic total gastrectomy (LTG) has ...not yet been proven due to the difficulty of the technique. This single-arm prospective multi-center study was conducted to evaluate the use of LTG for clinical stage I gastric cancer.
Methods
Between October 2012 and January 2014, 170 patients with pathologically proven, clinical stage I gastric adenocarcinoma located at the proximal stomach were enrolled. Twenty-two experienced surgeons from 19 institutions participated in this clinical trial. The primary end point was the incidence of postoperative morbidity and mortality at postoperative 30 days. The severity of postoperative complications was categorized according to Clavien–Dindo classification, and the incidence of postoperative morbidity and mortality was compared with that in a historical control.
Results
Of the enrolled patients, 160 met criteria for inclusion in the full analysis set. Postoperative morbidity and mortality rates reached 20.6% (33/160) and 0.6% (1/160), respectively. Fifteen patients (9.4%) had grade III or higher complications, and three reoperations (1.9%) were performed. The incidence of morbidity after LTG in this trial did not significantly differ from that reported in a previous study for open total gastrectomy (18%).
Conclusions
LTG performed by experienced surgeons showed acceptable postoperative morbidity and mortality for patients with clinical stage I gastric cancer.
•The Cl-doped LiMn1.5Ni0.5O4 presents better cyclic performance and rate capability.•The structural stability is enhanced by formation of strong Mn–Cl and Ni–Cl bonds.•The Li-ion diffusivity is ...improved by increase in lattice constant.
LiMn1.5Ni0.5O4 and LiMn1.5Ni0.5O3.9Cl0.1 are prepared by a solution-based process to investigate the influences of Cl doping on the structural and electrochemical properties of high voltage LiMn1.5Ni0.5O4 cathode materials for Li-ion batteries. LiMn1.5Ni0.5O3.9Cl0.1 features an improved cyclic performance at 30°C and 55°C compared with LiMn1.5Ni0.5O4, which originates from the enhanced structural stability by formation of strong Mn–Cl and Ni–Cl bonds revealed by XPS analysis. The improvement in the rate capability of LiMn1.5Ni0.5O3.9Cl0.1 is attributed to the facilitated Li-ion diffusion in the lattice, due primarily to the larger ionic radius of Cl than that of O. From the GITT analysis, it is revealed that the Li-ion diffusivity of LiMn1.5Ni0.5O3.9Cl0.1 is improved about 2 times compared with that of LiMn1.5Ni0.5O4. The improved Li-ion diffusivity in the lattice is assigned to the increase in the lattice constant of LiMn1.5Ni0.5O3.9Cl0.1 compared with that of LiMn1.5Ni0.5O4 by the doping of Cl.
OBJECTIVE:To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy.
BACKGROUND:Despite a lack of supporting evidence, robotic surgery has been ...increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy.
METHODS:A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis.
RESULTS:A total of 434 patients were enrolled for treatment with either robotic (n = 223) or laparoscopic (n = 211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n = 185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In per-protocol analysis, both group s showed similar overall complication rates (robotic = 11.9% vs laparoscopic = 10.3%) and major complication rates (robotic = 1.1% vs laparoscopic = 1.1%) with no operative mortality in either group. Patients treated with robotic surgery showed significantly longer operative time (robotic = 221 minutes vs laparoscopic = 178 minutes; P < 0.001) and significantly higher total costs (robotic = US$13,432 vs laparoscopic = US$8090; P < 0.001), compared with those who underwent laparoscopic gastrectomy. No significant differences between groups were noted in estimated blood loss, rates of open conversion, diet build-up, or length of hospital stay.
CONCLUSIONS:The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identificationNCT01309256.
IMPORTANCE: Acute isovolemic anemia occurs when blood loss is replaced with fluid. It is often observed after surgery and negatively influences short-term and long-term outcomes. OBJECTIVE: To ...evaluate the efficacy and safety of ferric carboxymaltose to treat acute isovolemic anemia following gastrectomy. DESIGN, SETTING, AND PARTICIPANTS: The FAIRY trial was a patient-blinded, randomized, phase 3, placebo-controlled, 12-week study conducted between February 4, 2013, and December 15, 2015, in 7 centers across the Republic of Korea. Patients with a serum hemoglobin level of 7 g/dL to less than 10 g/dL at 5 to 7 days following radical gastrectomy were included. INTERVENTIONS: Patients were randomized to receive a 1-time or 2-time injection of 500 mg or 1000 mg of ferric carboxymaltose according to body weight (ferric carboxymaltose group, 228 patients) or normal saline (placebo group, 226 patients). MAIN OUTCOMES AND MEASURES: The primary end point was the number of hemoglobin responders, defined as a hemoglobin increase of 2 g/dL or more from baseline, a hemoglobin level of 11 g/dL or more, or both at week 12. Secondary end points included changes in hemoglobin, ferritin, and transferrin saturation levels over time, percentage of patients requiring alternative anemia management (oral iron, transfusion, or both), and quality of life at weeks 3 and 12. RESULTS: Among 454 patients who were randomized (mean age, 61.1 years; women, 54.8%; mean baseline hemoglobin level, 9.1 g/dL), 96.3% completed the trial. At week 12, the number of hemoglobin responders was significantly greater for ferric carboxymaltose vs placebo (92.2% 200 patients for the ferric carboxymaltose group vs 54.0% 115 patients for the placebo group; absolute difference, 38.2% 95% CI, 33.6%-42.8%; P = .001). Compared with the placebo group, patients in the ferric carboxymaltose group experienced significantly greater improvements in serum ferritin level (week 12: 233.3 ng/mL for the ferric carboxymaltose group vs 53.4 ng/mL for the placebo group; absolute difference, 179.9 ng/mL 95% CI, 150.2-209.5; P = .001) and transferrin saturation level (week 12: 35.0% for the ferric carboxymaltose group vs 19.3% for the placebo group; absolute difference, 15.7% 95% CI, 13.1%-18.3%; P = .001); but there were no significant differences in quality of life. Patients in the ferric carboxymaltose group required less alternative anemia management than patients in the placebo group (1.4% for the ferric carboxymaltose group vs 6.9% for the placebo group; absolute difference, 5.5% 95% CI, 3.3%-7.6%; P = .006). The total rate of adverse events was higher in the ferric carboxymaltose group (15 patients 6.8%, including injection site reactions 5 patients and urticaria 5 patients) than the placebo group (1 patient 0.4%), but no severe adverse events were reported in either group. CONCLUSION AND RELEVANCE: Among adults with isovolemic anemia following radical gastrectomy, the use of ferric carboxymaltose compared with placebo was more likely to result in improved hemoglobin response at 12 weeks. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01725789
After gastrectomy, patients may experience the postgastrectomy syndrome and face difficulties adapting to everyday diet. Recently, human health coaching via a mobile application (app) has been used ...for obese patients or patients with chronic diseases, with significant improvements in clinical outcomes. The aim of this study is to evaluate and compare the effects of human health coaching via a mobile app and conventional face-to-face counseling in patients who underwent gastrectomy for gastric cancers.
This study is a single-institution, prospective randomized controlled trial comparing the mobile health and face-to-face counselling groups. After randomization, participants assigned to the mobile health coaching group will receive health coaching via a mobile app for 3 months after discharge, and the assigned coaches will provide personalized advice based on the self-recorded health data. Participants in the face-to-face group will have 1- and 3-months postoperative dietary consultations with a clinical dietitian. The primary endpoint is the food restriction score on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-STO22, and secondary endpoints included all other quality of life scale scores and nutritional parameters. The calculated sample size is 180, and the outcomes will be measured until 1-year post-surgery.
This study will show the efficacy of human health coaching via a mobile app on dietary adaptation in patients who underwent gastrectomy. A relational approach based on personal data and timely intervention using a mobile platform could reduce patients' trial and error and improve quality of life.
ClinicalTrials.gov, NCT04394585, Registered 19 May, 2020 -Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT040394585.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Endoscopic resection (ER) of early gastric cancer (EGC) meeting the absolute indication has excellent long-term outcomes. Objective To compare long-term outcomes of ER with those of ...surgery in patients with EGC who met the absolute indication for ER. Design Retrospective cohort study. Setting A specialized center for the treatment of cancer. Patients and Interventions We retrospectively reviewed data from patients who underwent gastrectomy or ER for EGC between 2002 and 2007. Gastric cancers were differentiated-type adenocarcinoma without ulceration confined to the mucosal layer and 2 cm or smaller in size. Main Outcome Measurements The primary outcome was overall survival (OS). Metachronous cancer rates and adverse event rates were compared. Kaplan-Meier plots and Cox proportional hazard regression analyses were applied for comparisons. Differences in baseline characteristics were adjusted by propensity score. Results Among 375 patients, 261 underwent ER and 114 underwent surgery. The median follow-up duration was 76.4 months. The 5-year OS rates did not significantly differ between the ER and surgery groups (95.7% vs 93.6%, respectively; P = .725 by log-rank test). There were no gastric cancer–related deaths in either group. Metachronous gastric cancer developed more frequently in the ER group (6.1%, 16/261) than in the surgery group (0.9%, 1/114) ( P = .024). However, most patients (93.8%, 15/16) in the ER group were curatively treated with repeat ER. Adverse event rates were higher in the surgery group than those in the ER group (7.9% vs 2.7%, P = .028). Limitations Retrospective, single-center study. Conclusions The OS rate after ER for mucosal gastric cancer that met the absolute indication was comparable to that achieved with surgery. Although metachronous cancers were more common after ER, they were usually treatable and did not affect survival.
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