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The detection rate of gastric submucosal tumor (SMT) and early gastric cancer has been increasing year by year. The type of treatment should be selected to keep gastric function as more as possible because of both SMT and early gastric cancer with good prognosis. Endoscopy and the combination of laparoscopic and endoscopic cooperative surgery can be the choice. Laparoscopic intragastric surgery (LIGS) contains the advantages of both laparoscopy and endoscopy and can be performed by the surgeon only. LIGS has been applied to gastric submucosal tumors and early gastric cancer based on the continuous improvement of the procedure and instruments of LIGS. The application including the advantage and disadvantage of LIGS were reviewed in this paper.

The restoration of fine motor function in the hand is crucial for stroke survivors with hemiplegia to reintegrate into daily life and presents a significant challenge in post-stroke rehabilitation. Current mirror rehabilitation systems based on wearable devices require medical professionals or caregivers to assist patients in donning sensor gloves on the healthy side, thus hindering autonomous training, increasing labor costs, and imposing psychological burdens on patients. This study developed a low-load wearable hand function mirror rehabilitation robotic system based on visual gesture recognition. The system incorporates an active visual apparatus capable of adjusting its position and viewpoint autonomously, enabling the subtle monitoring of the healthy side's gesture throughout the rehabilitation process. Consequently, patients only need to wear the device on their impaired hand to complete the mirror training, facilitating independent rehabilitation exercises. An algorithm based on hand key point gesture recognition was developed, which is capable of automatically identifying eight distinct gestures. Additionally, the system supports remote audio–video interaction during training sessions, addressing the lack of professional guidance in independent rehabilitation. A prototype of the system was constructed, a dataset for hand gesture recognition was collected, and the system's performance as well as functionality were rigorously tested. The results indicate that the gesture recognition accuracy exceeds 90% under ten-fold cross-validation. The system enables operators to independently complete hand rehabilitation training, while the active visual system accommodates a patient's rehabilitation needs across different postures. This study explores methods for autonomous hand function rehabilitation training, thereby offering valuable insights for future research on hand function recovery. [ABSTRACT FROM AUTHOR]

Key Points: Question: Does adding sintilimab, an IgG4 monoclonal antibody that binds to programmed cell death 1 (PD-1), to first-line chemotherapy improve survival for patients with previously untreated advanced gastric and gastroesophageal junction adenocarcinoma, both overall and in the subset of patients with the PD ligand 1 (PD-L1) combined positive score (CPS) of 5 or more? Findings: In this randomized clinical trial of 650 patients, from 62 centers in China, with previously untreated advanced gastric or gastroesophageal junction adenocarcinoma, the combination of sintilimab with chemotherapy compared with placebo with chemotherapy significantly improved overall survival in all randomized patients (median, 15.2 vs 12.3 months) and in patients with a CPS of 5 or more (median, 18.4 vs 12.9 months). Meaning: Among patients with previously untreated advanced gastric or gastroesophageal junction adenocarcinoma, adding sintilimab to chemotherapy significantly improved overall survival, compared with placebo with chemotherapy, among all randomized patients and in patients with a CPS of 5 or more. Importance: Gastric and gastroesophageal junction cancers are diagnosed in more than 1 million people worldwide annually, and few effective treatments are available. Sintilimab, a recombinant human IgG4 monoclonal antibody that binds to programmed cell death 1 (PD-1), in combination with chemotherapy, has demonstrated promising efficacy. Objective: To compare overall survival of patients with unresectable locally advanced or metastatic gastric or gastroesophageal junction cancers who were treated with sintilimab with chemotherapy vs placebo with chemotherapy. Also compared were a subset of patients with a PD ligand 1 (PD-L1) combined positive score (CPS) of 5 or more (range, 1-100). Design, Setting, and Participants: Randomized, double-blind, placebo-controlled, phase 3 clinical trial conducted at 62 hospitals in China that enrolled 650 patients with unresectable locally advanced or metastatic gastric or gastroesophageal junction adenocarcinoma between January 3, 2019, and August 5, 2020. Final follow-up occurred on June 20, 2021. Interventions: Patients were randomized 1:1 to either sintilimab (n = 327) or placebo (n = 323) combined with capecitabine and oxaliplatin (the XELOX regimen) every 3 weeks for a maximum of 6 cycles. Maintenance therapy with sintilimab or placebo plus capecitabine continued for up to 2 years. Main Outcomes and Measures: The primary end point was overall survival time from randomization. Results: Of the 650 patients (mean age, 59 years; 483 [74.3%] men), 327 were randomized to sintilimab plus chemotherapy and 323 to placebo plus chemotherapy. Among the randomized patients, 397 (61.1%) had tumors with a PD-L1 CPS of 5 or more; 563 (86.6%) discontinued study treatment and 388 (59.7%) died; 1 patient (<0.1%) was lost to follow-up. Among all randomized patients, sintilimab improved overall survival compared with placebo (median, 15.2 vs 12.3 months; stratified hazard ratio [HR], 0.77 [95% CI, 0.63-0.94]; P =.009). Among patients with a CPS of 5 or more, sintilimab improved overall survival compared with placebo (median, 18.4 vs 12.9 months; HR, 0.66 [95% CI, 0.50-0.86]; P =.002). The most common grade 3 or higher treatment-related adverse events were decreased platelet count (sintilimab, 24.7% vs placebo, 21.3%), decreased neutrophil count (sintilimab, 20.1% vs placebo, 18.8%), and anemia (sintilimab, 12.5% vs placebo, 8.8%). Conclusions and Relevance: Among patients with unresectable locally advanced or metastatic gastric and gastroesophageal junction adenocarcinoma treated with first-line chemotherapy, sintilimab significantly improved overall survival for all patients and for patients with a CPS of 5 or more compared with placebo. Trial Registration: ClinicalTrials.gov Identifier: NCT03745170 This randomized clinical trial evaluates whether sintilimab plus chemotherapy vs placebo plus chemotherapy improved overall survival in patients in China with unresectable, locally advanced, recurrent, or metastatic gastric or gastroesophageal junction adenocarcinoma. [ABSTRACT FROM AUTHOR]

Natural killer (NK) cells are the critical elements of the innate immune response and implicated in rapidly recognizing and eliminating cancer cells. However, the tumor‐suppressive ability of NK cells is often impaired in several cancer types. The critical roles of microRNAs have been elucidated by increasing evidences, while the regulation of miR‐338‐3p in anti‐tumor activation of NK cells and its relationship with estrogen in breast cancer (BC) are still confusing. Here, miR‐338‐3p level was found to be significantly downregulated in BC tissues and estrogen receptor positive (ER+) cells, this difference was more obvious in ER+ patients or BC patients at advanced stage (TNM III and IV). MiR‐338‐3p level was shown to be downregulated by 17β‐estradiol in BC cells (MDA‐MB‐231 cells and MCF‐7) in vitro. MiR‐338‐3p overexpression decreased disintegrin and metalloprotease‐17 (ADAM17) secretion in MDA‐MB‐231 (ER−) and MCF‐7 (ER+) cells. In addition, miR‐338‐3p overexpression or treatment with anti‐ADAM17 antibody could down‐regulate granzyme B, CD16, and NKG2D in NK cells, which was reversed by human recombinant ADAM17. Furthermore, these educated NK cells could promote the viability of MDA‐MB‐231 or MCF‐7 cells. Taken together, our results demonstrate that miR‐338‐3p was negatively regulated by estrogen in BC cells, impairing NK cell's activity by the up‐regulation of ADAM17, and conversely promoted the viability of BC cells. Therefore, the estrogen/miR‐338‐3p/ADAM17 axis is critically implicated in BC pathogenesis and may provide potential targets for BC diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Philosophy extends from literature to art, religion, history, and archaeology, and tries to pay attention to the philosophical interpretation of ancient Chinese images. This paper highlights the interaction between literature narration and cultural relic image narration and brings methodological enlightenment to philosophical "comparison", starting with the concepts of the Witchcraft and the ecstasy, this paper reinterprets the bird totem image of ancient Chinese civilization and explores the bird worship cosmology and outlook on life hidden in ancient Chinese civilization. This paper emphasizes the role of "comparative" philosophy as important evidence of theoretical interpretation in re contextualizing the literature narration of ancient civilization and the image narration of cultural relics. This is significant because it concludes that prehistoric Chinese humans were good at using the image of birds as the metaphor for their soul of obsessive consciousness. This conclusion will help us understand the psychic artist insisted on giving the bird totem art a strange power to construct ideas, and this idea has been dispensable for contemporary mankind. This will help us better understand the ancient witchcraft artistic consciousness embodied in the prehistoric bird totem. I take it as an example of how the Enlightenment rationality should be reflected and criticized. They are an important force for modern people to return to their mythological origin and save the modern crisis caused by the loss of core cultural values. [ABSTRACT FROM AUTHOR]