Effect of PVA Fiber on the Mechanical Properties of Seawater Coral Sand Engineered Cementitious Composites.

The physical and mechanical characteristics of seawater coral sand engineered cementitious composites (SCECC) were examined through uniaxial compression, three-point bending, and splitting tensile tests. The mechanical properties were scrutinized under varying fiber volume fraction conditions (V = 0%, 0.575%, 1.150%, 1.725%, and 2.300%). The experimental results indicated that the compressive strength, three-point bending strength, and split tensile strength of SCECC tended to increase with the rise in fiber volume fraction. The strengths attained their maximum values of 45.88, 12.56, and 3.03 MPa when the fiber volume fraction reached 2.300%. In the compression test, the compressive strength of the 7-day specimen can achieve more than 78.50% of that observed in the 28-day specimen. Three-point bending test has revealed that SCECC exhibits favorable strain-hardening and multi-crack cracking characteristics. Fracture patterns of SCECC exhibited variations corresponding to changes in fiber content, as illustrated by their load-deformation curves, the addition of PVA fibers can change the damage mode of cementitious composites from brittle to ductile. The fracture energy of SCECC further attests to its elevated toughness. This is due to the fact that the fibers delay the formation of microcracks and prevent crack expansion, thus significantly increasing the deformability of the material. By verifying its strength, deformability, fracture energy, and other key performance indicators, the feasibility of SCECC in coastal construction projects has been clarified. The successful development of SCECC provides an innovative and high-performance option for the construction of future island projects.

Semantic-Aware Modular Capsule Routing for Visual Question Answering.

Visual Question Answering (VQA) is fundamentally compositional in nature, and many questions are simply answered by decomposing them into modular sub-problems. The recent proposed Neural Module Network (NMN) employ this strategy to question answering, whereas heavily rest with off-the-shelf layout parser or additional expert policy regarding the network architecture design instead of learning from the data. These strategies result in the unsatisfactory adaptability to the semantically-complicated variance of the inputs, thereby hindering the representational capacity and generalizability of the model. To tackle this problem, we propose a Semantic-aware modUlar caPsulE Routing framework, termed as SUPER, to better capture the instance-specific vision-semantic characteristics and refine the discriminative representations for prediction. Particularly, five powerful specialized modules as well as dynamic routers are tailored in each layer of the SUPER network, and the compact routing spaces are constructed such that a variety of customizable routes can be sufficiently exploited and the vision-semantic representations can be explicitly calibrated. We comparatively justify the effectiveness and generalization ability of our proposed SUPER scheme over five benchmark datasets, as well as the parametric-efficient advantage. It is worth emphasizing that this work is not to pursue the state-of-the-art results in VQA. Instead, we expect that our model is responsible to provide a novel perspective towards architecture learning and representation calibration for VQA.

A combined diagnostic model based on circulating tumor cell in patients with solitary pulmonary nodules.

BACKGROUND: Although many prediction models in diagnosis of solitary pulmonary nodules (SPNs) have been developed, few are widely used in clinical practice. It is therefore imperative to identify novel biomarkers and prediction models supporting early diagnosis of SPNs. This study combined folate receptor-positive circulating tumor cells (FR+ CTC) with serum tumor biomarkers, patient demographics and clinical characteristics to develop a prediction model. METHODS: A total of 898 patients with a solitary pulmonary nodule who received FR+ CTC detection were randomly assigned to a training set and a validation set in a 2:1 ratio. Multivariate logistic regression was used to establish a diagnostic model to differentiate malignant and benign nodules. The receiver operating curve (ROC) and the area under the curve (AUC) were calculated to assess the diagnostic efficiency of the model. RESULTS: The positive rate of FR+ CTC between patients with non-small cell lung cancer (NSCLC) and benign lung disease was significantly different in both the training and the validation dataset (p < 0.001). The FR+ CTC level was significantly higher in the NSCLC group compared with that of the benign group (p < 0.001). FR+ CTC (odds ratio, OR, 95% confidence interval, CI: 1.13, 1.07-1.19, p < 0.0001), age (OR, 95% CI: 1.06, 1.01-1.12, p = 0.03) and sex (OR, 95% CI: 1.07, 1.01-1.13, p = 0.01) were independent risk factors of NSCLC in patients with a solitary pulmonary nodule. The area under the curve (AUC) of FR+ CTC in diagnosing NSCLC was 0.650 (95% CI, 0.587-0.713) in the training set and 0.700 (95% CI, 0.603-0.796) in the validation set, respectively. The AUC of the combined model was 0.725 (95% CI, 0.659-0.791) in the training set and 0.828 (95% CI, 0.754-0.902) in the validation set, respectively. CONCLUSIONS: We confirmed the value of FR+ CTC in diagnosing SPNs and developed a prediction model based on FR+ CTC, demographic characteristics, and serum biomarkers for differential diagnosis of solitary pulmonary nodules.

Genomic and clinicopathological features of lung adenocarcinomas with micropapillary component.

Background: Lung adenocarcinoma (LA) with a micropapillary component (LAMPC) is a histological subtype of lung cancer that has received increasing attention due to its correlation with poor prognosis, and its tendency to recur and metastasize. At present, comprehensive genomic profiles and clinicopathological features for LAMPC remain unclear and require further investigation. Methods: From September 2009 to October 2020, a total of 465 LAMPC patients were recruited and divided into four groups according to MPC proportions, and the correlations between varying proportions of MPCs and clinicopathological characteristics were analyzed. Twenty-nine (29) LAMPC patients and 89 LA patients without MPC (non-MPC) that had undergone NGS testing were selected for further study The comprehensively analyze genomic variations and the difference between LAMPC and MPC were determined. In addition, Gene alterations of LAMPC between Chinese and Western populations were also compared using cBioPortal data. Results: A higher proportion of MPCs, associated with higher tumor stage, pleural invasion, and vascular tumor thrombus formation, was determined in LA patients. Compared to non-MPC patients, LAMPC patients were determined to have a lower frequency of single nucleotide variants and a higher frequency of insertion-deletion mutations. Mutations in TP53, CTNNB1, and SMAD4, and ALK rearrangements/fusions were significantly more frequent in LAMPC patients. ERBB2 mutations were only detected in non-MPC patients. Gene mutations in the Wnt pathway were significantly more common in LAMPC patients as compared to non-MPC patients. ALK fusions were more prevalent in younger patients. Patients with KRAS or LBP1B mutations had significantly larger tumor diameters than patients with wild-type KRAS or LBP1B. Patients with KRAS mutations were more likely to develop vascular tumor thrombus. Using the cBioPortal public database, we determined that mutations in EGFR were significantly higher in Chinese patients than in a Memorial Sloan Kettering Cancer Center (MSKCC) Western cohort. ALK fusions were exclusively detected in the Chinese cohort, while mutations in KEAP1 and NOTCH4 were only detected in the MSKCC cohort. Our analysis of signaling pathways revealed that Wnt pathway gene mutations were significantly higher in the Chinese cohort. Conclusion: LA patients with higher proportions of MPCs were determined to have a higher tumor stage, pleural invasion, and vascular tumor thrombosis formation. We comprehensively analyzed the genomic mutation characteristics of LAMPC patients and identified multiple, novel MPC-related gene alterations and pathway changes. Our data provide further understanding of the nature of the LAMPC and potential drug-targeted gene alterations, which may lead to new therapeutic strategies.

Preoperative Neutrophil to Lymphocyte Ratio Predicts Complications After Esophageal Resection That can be Used as Inclusion Criteria for Enhanced Recovery After Surgery.

Background: The neutrophil to lymphocyte ratio (NLR) has been reported as an indicator for poor prognosis in many cancers including esophageal cancer. However, the relationship between the NLR and postoperative complications after esophageal cancer resection remains unclear. At present, enhanced recovery after surgery (ERAS) lacks inclusion criteria. The aim of this study is to determine whether the preoperative NLR (preNLR) can predict complications after esophageal cancer resection, which could represent the criteria for ERAS. Methods: This was a retrospective study on 171 patients who underwent esophagectomy at Hospital between November 2020 and November 2021(68 patients from Changhai Hospital, 65 patients from Shanghai General Hospital and 38 patients from Affiliated Hospital of Qingdao University). Univariate and multivariate logistic regression analyses were performed to demonstrate that the preNLR could predict complications after esophagectomy. Results: A preNLR cutoff value of 2.30 was identified as having the greatest ability to predict complications with a sensitivity of 76% and specificity of 65%. Moreover, the Chi-squared test results showed that the preNLR was significantly associated with complications (x2 = 13.641, p < 0.001), and multivariate logistic regression analysis showed that body mass index (BMI), p stage and preNLR were independent variables associated with the development of postoperative complications (p < 0.05). Conclusion: The preNLR can predict complications after esophagectomy, and these predicted complications can represent the criteria for recruiting patients for ERAS.

TRIM23 overexpression is a poor prognostic factor and contributes to carcinogenesis in colorectal cancer.

The tripartite motif (TRIM) family proteins play a great role in carcinogenesis. However, the expression pattern, prognostic value and biological functions of tripartite motif containing 23 (TRIM23) in colorectal cancer (CRC) are poorly understood. Here, we found that TRIM23 is up-regulated and associated with tumour size, lymph node metastasis, American Joint Committee on Cancer (AJCC) stage and poor prognosis in CRC. Multivariate Cox regression analyses revealed that TRIM23 overexpression could be identified as an independent prognostic factor for CRC. TRIM23 could promote the proliferation of CRC cell in vitro and in vivo; additionally, TRIM23 depletion induced G1-phase arrest. Gene set enrichment analysis (GSEA) revealed that P53 and cell cycle signalling pathway-related genes were enriched in patients with high TRIM23 expression levels. We show in this study that TRIM23 physically binds to P53 and enhances the ubiquitination of P53, thereby promoting tumour proliferation. Thus, our data indicated that TRIM23 acts as an oncogene in colorectal carcinogenesis and may provide a novel therapeutic target for CRC management.

[Expression of TRIM59 in Non-small Cell Lung Cancer and Its Correlation with Prognosis].

BACKGROUND: TRIM proteins are important members of E3 ubiquitin ligases, and many studies have confirmed that TRIM family members play an important role in the development of various tumors. We found that TRIM59 expression level in non-small cell lung cancer (NSCLC) was significantly increased through second-generation sequencing. The purpose of this study was to investigate the expression of TRIM59 in NSCLC and its relationship with the clinicopathological parameters as well as the prognosis of patients. METHODS: The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets were excavated to analyze the expression of TRIM59 mRNA in NSCLC and its relationship with the prognosis of patients; The expression of TRIM59 protein in 90 tumor tissues and adjacent tissues was detected by immunohistochemical staining, and the relationship between the expression of TRIM59 protein and clinicopathological parameters and prognosis was analyzed. RESULTS: Overexpression of TRIM59 mRNA in tumor tissues predicted poor prognosis. The expression level of TRIM59 protein was significantly higher in tumor tissues than in adjacent tissues, and TRIM59 protein expression was correlated with tumor size (P=0.007), tumor differentiation (P=0.009), tumor-node-metastasis (TNM) stage (P=0.003) and lymph node metastasis (P=0.003). Multivariate Cox regression analyses showed that along with TNM stage, overexpression of TRIM59 could be considered an independent prognostic factor for NSCLC patients. CONCLUSIONS: The expression of TRIM59 is closely related to the prognosis of NSCLC patients, and it is an independent risk factor for NSCLC patients.

Discrete Optimal Graph Clustering.

Graph-based clustering is one of the major clustering methods. Most of it works in three separate steps: 1) similarity graph construction; 2) clustering label relaxing; and 3) label discretization with k -means (KM). Such common practice has three disadvantages: 1) the predefined similarity graph is often fixed and may not be optimal for the subsequent clustering; 2) the relaxing process of cluster labels may cause significant information loss; and 3) label discretization may deviate from the real clustering result since KM is sensitive to the initialization of cluster centroids. To tackle these problems, in this paper, we propose an effective discrete optimal graph clustering framework. A structured similarity graph that is theoretically optimal for clustering performance is adaptively learned with a guidance of reasonable rank constraints. Besides, to avoid the information loss, we explicitly enforce a discrete transformation on the intermediate continuous label, which derives a tractable optimization problem with a discrete solution. Furthermore, to compensate for the unreliability of the learned labels and enhance the clustering accuracy, we design an adaptive robust module that learns the prediction function for the unseen data based on the learned discrete cluster labels. Finally, an iterative optimization strategy guaranteed with convergence is developed to directly solve the clustering results. Extensive experiments conducted on both real and synthetic datasets demonstrate the superiority of our proposed methods compared with several state-of-the-art clustering approaches.

Stress⁻Strain Properties and Gas Permeability Evolution of Hybrid Fiber Engineered Cementitious Composites in the Process of Compression.

Polyvinyl alcohol (PVA)-steel hybrid fiber reinforced engineered cementitious composites (ECC) characterized by optimal combination of high strength and high ductility were developed recently. These composites exhibit even tighter crack width than normal ECC, showing great potential for lower permeability in cracked state, and consequently improving the durability of ECC structures. In addition, the wide variety of promising applications in underground or hydraulic structures calls for knowledge on the mechanical behavior and corresponding permeability properties of strained ECC under multiaxial stress, as they are essential for structural analysis and durability design. Experimental investigations into the compressive properties and the in-situ gas permeability of PVA-steel hybrid fiber ECC were performed in this study, with special focus on the impact of additional steel fiber content and confining pressure. The test results show that the presence of a low confinement level allows ECC to attain a substantial improvement on compressive behavior but impairs the enhancement efficiency of additional steel fiber. The permeability evolution of strained ECC corresponds to the variation of radial strains, both of which experience little change below the threshold stress but a rapid increase beyond the peak axial strain. Apart from exhibiting low permeability at relatively small strains in the pre-peak stage, ECC can also exhibit low permeability at higher levels of compressive strain up to 2.0%. However, unlike the case in tensile loading, impermeability of cracked ECC in compression would be weakened by additional steel fibers, especially in the post-peak stage. The present research is expected to provide insight into performance-based durability design of structures made of or strengthened with ECC.

Correction: Preoperative Prediction of Ki-67 Labeling Index By Three-dimensional CT Image Parameters for Differential Diagnosis Of Ground-Glass Opacity (GGO).

[This corrects the article DOI: 10.1371/journal.pone.0129206.].

Prognostic model based on circular RNA circPDK1 for resected lung squamous cell carcinoma.

BACKGROUND: Circular RNA has been revealed as a potential biomarker in multiple malignancies. However, few studies have focused on its potential to be prognostic markers in lung squamous cell carcinoma (LSCC). In this work, we aimed to build a prognostic model of resected LSCC based on circular RNA pyruvate dehydrogenase kinase 1 (circPDK1) and other clinicopathological factors. METHODS: circPDK1 was identified via next-generation sequencing. Three hundred two cases of LSCC tissue and their adjacent normal lung tissues were obtained from multiple medical centers and divided into study cohort (n=232) and validation cohort (n=70). The expression of circPDK1 was detected for analyzing its potential prognostic value for recurrence-free survival (RFS) and overall survival (OS) in LSCC. Finally, combined with circPDK1, T staging, lymph nodes (LN) metastasis status, age, and serum squamous cell Carcinoma Antigen (SCCAg), we built a prognostic model by nomograms method and confirmed it in the validation cohort. RESULTS: CircPDK1 was identified to be overexpressed (P<0.01) in LSCC. Through analysis in study cohort, circPDK1low patients (less than the mean expression, n=124) showed more lymph nodes metastasis (P=0.025), more vascular invasion (VI) (P=0.047), more visceral pleural invasion (VPI) (P=0.015) and poorer prognosis (P=0.003) than circPDK1high ones (n=108). Univariate and multivariate analysis showed that circPDK1, T staging, LN status, age, and SCCAg were significant prognostic factors for RFS and OS. The prognostic model based on these factors showed the concordance index (C-index) of 0.8214 and 0.8359 for predicting 5-year RFS and OS, respectively. Finally, the calibration curves were performed in the study cohort and a validation cohort to evaluate the model's efficiency. CONCLUSIONS: circPDK1 was identified as a potential biomarker of resected LSCC. The prognostic model including circPDK1, T staging, LN status, age, and SCCAg could effectively predict prognosis of resected LSCC.

Testes-specific protease 50 as an independent risk factor for poor prognosis in patients with non-small cell lung cancer.

Testes-specific protease 50 (TSP50) is normally expressed in the testes and is overexpressed in various types of human cancers, including breast cancer, colorectal carcinoma and laryngocarcinoma. However, little has been reported on the association between TSP50 and non-small cell lung cancer (NSCLC). The present study aimed to detect TSP50 expression in 198 strict follow-up cases of paired NSCLC and 15 cases of normal lung parenchymal specimens using immunohistochemical staining. The expression levels of TSP50 were then correlated with the clinicopathological factors of NSCLC to assess its potential diagnostic and prognostic value. The relationship between TSP50 expression and the clinicopathological parameters of NSCLC was evaluated using χ2 and Fisher's exact tests. Survival rates for the overall population (n=198) were calculated using the Kaplan-Meier method, and univariate and multivariate analyses were performed using the Cox's proportional hazards regression model. P<0.05 was considered to indicate a statistically significant difference. The expression of TSP50 was significantly increased in NSCLC tissue compared with in adjacent non-tumor or normal lung parenchymal tissue (P<0.001). A significant association was revealed between high expression levels of TSP50 and clinicopathological characteristics including tumor differentiation (P=0.012), late tumor status (P=0.004) and late tumor node metastasis stage (P=0.026), as well as a reduced disease free survival (P=0.009) and overall survival rate (P=0.002) in all patients with NSCLC. Multivariate analyses demonstrated that high TSP50 expression in tumor tissues was significantly associated with a shorter disease-free survival rate [hazard ratio (HR) =1.590, 95% confidence interval (CI): 1.035-2.441], and with a shorter overall survival rate (HR=1.814; 95% CI: 1.156-2.846). In conclusion, the present data demonstrated that increased TSP50 protein expression may be a potential predictor of early recurrence and poor prognosis in NSCLC, and that TSP50 expression levels possess the potential to be used as a biomarker and therapeutic target for the treatment of patients with NSCLC.

TRIM47 overexpression is a poor prognostic factor and contributes to carcinogenesis in non-small cell lung carcinoma.

Non-small cell lung carcinoma (NSCLC) is the most common malignancy with the highest morbidity and mortality. In this study, we found that tripartite motif containing 47 (TRIM47) expression level was higher in tumor tissues than in normal adjacent tissues. Overexpression of TRIM47 closely correlated with poor prognosis in patients with NSCLC. Multivariate Cox regression analyses showed that TRIM47 overexpression could be considered an independent prognostic factor for NSCLC. TRIM47 depletion significantly inhibited cell proliferation and induced G1phase arrest in A549 and H358 cell lines. Moreover, TRIM47 silencing remarkably inhibited cell migration, cell invasion, and tumorigenicity in nude mice. Gene set enrichment analysis (GSEA) revealed that cancer-related process and pathways, including p53-cell cycle and NFκB-epithelial mesenchymal transition (EMT) pathway, were significantly correlated with TRIM47 expression. Real-time PCR and Western blot analysis revealed that TRIM47 exerts an inhibitory effect on p53 and an facilitatory effect on NF-κB, thereby promoting tumor proliferation and metastasis. Taken together, TRIM47 acts as a tumor oncogene in NSCLC. Our data provide insight into the possible biological mechanism of TRIM47 in the progression of NSCLC and highlight its usefulness as a potential therapeutic target.

Quality-control method for the determination of biological activity of engineered calcineurin subunit B.

The aim of this study was to establish a quality-control method for calcineurin subunit B (CNB) biological activity determinations. CNB enhances the p-nitrophenylphosphate (pNPP) dephosphorylating activity of calcineurin subunit A Δ316 mutant (CNAΔ316). A series of CNB concentrations were fitted to a four-parameter equation to calculate the corresponding pNPP maximum dephosphorylation rates. Values were calculated based on biological activity references using a parallel line method. The method was then validated for accuracy, precision, linearity, linear range, sensitivity, specificity, and robustness. The recovery results were greater than 98%. Intra-plate precision was 6.7%, with inter-plate precision of 10.8%. The coefficient of determination was greater than 0.98. The linear range was 0.05-50 µg mL(-1), with sensitivity of 50 µg mL(-1). Tested cytokines did not induce CNAΔ316 dephosphorylation of pNPP. The chosen CNAΔ316 concentration range did not affect activity determinations.

[Research Progress of PR Domain Zinc Finger Protein 14].

PR domain zinc finger protein 14 (PRDM14) is an important member of the PRDM family, PRDM14 plays a key role in the maintenance of cell integrity and differentiation, growth and apoptosis of the cell. It also plays an critical role in the formation of primordial germ cells, the maintenance of the totipotency of stem cells and the formation of tissues and organs. PRDM14 bears a single PR domain and six tandemly repeated zinc fingers, which is involved in the process of the deacetylation and methylation of the histone, and is involved in the formation of tumor trough the change level of methylation in the promoter region. The abnormal methylation of PRDM14 can change the chromatin structure, DNA conformation and the interaction mode of DNA and protein, it can suppress transcription and expression of the gene, which caused the occurrence, development and metastasis of tumor. The research progress of PRDM14 is reviewed based on the relevant literatures published in China and abroad.

Overexpression and biological function of TMEM48 in non-small cell lung carcinoma.

Transmembrane protein 48 (TMEM48), localized to nuclear pore complexes (NPCs), has been reported crucial for NPC assembly. Alterations in NPC members have been reported in several malignancies. The present study was aimed to elucidate the expression and biological function of TMEM48 in non-small cell lung carcinoma (NSCLC). Here, TMEM48 expression level was higher in NSCLC tissues than that in the adjacent normal tissues. Moreover, higher TMEM48 expression was correlated with a more advanced tumor stage, lymph node metastasis, bigger tumor size tumor stage, and shorter survival time. Knockdown of TMEM48 in NSCLC cell lines, A549 and H1299, inhibited cell proliferation and significantly increased cells population in G1 phase. Gene set enrichment analysis (GSEA) showed that cell cycle pathway was correlative with the TMEM48 expression. Additionally, real-time PCR and western blot analysis revealed that several cell cycle and DNA replication genes, including Cyclin B1, CDK1, CDC6, PCNA, and RCF4, were reduced after TMEM48 knockdown. Additionally, inhibition of TMEM48 in NSCLC cells significantly stimulated cell apoptosis, while notably repressed cell adhesion, migration, invasion, and tumorigenicity in nude mice. Our data provide insight into the biological relevance of TMEM48 in NSCLC progression and highlight its usefulness as a prognostic factor and potential therapeutic target in NSCLC.

Pulmonary ground-glass nodules diagnosis: mean change rate of peak CT number as a discriminative factor of pathology during a follow-up.

OBJECTIVE: We aimed to analyse the peak CT number (PEAK) in CT number histogram of ground-glass nodules (GGN), meaning the most frequent density of pixels in the image of pulmonary nodule, based on three-dimensional (3D) reconstructive model pre-operatively, and the mean rate of PEAK change (V-PEAK) during a follow-up of GGN for differential diagnosis between pre-invasive adenocarcinoma (PIA) and invasive adenocarcinoma (IAC). METHODS: CT number histogram of pixels in GGN was made automatically by 3D measurement software. Diameter, total volume, PEAK and V-PEAK were measured from CT data sets of different groups classified by pathology, subtype and number of GGN, respectively. RESULTS: Among all 102 cases, 47 were PIA, including atypical adenomatous hyperplasia (n = 29) and adenocarcinoma in situ (n = 18), and 55 were IAC, including minimally IAC (MIA, n = 4). By Wilcoxon test, PEAK of IAC was significantly higher than that of PIA (p < 0.001). By receiver operating curve analysis, area under the curve (AUC) was 0.857 and threshold -820.50 Hounsfield units (HU) for differentiation between PIA and IAC. V-PEAK of IAC was unexpectedly remarkably smaller than that of PIA (p < 0.001) with AUC and threshold being 0.810 and -0.829 HU day(-1), respectively. CONCLUSION: Pre-operative PEAK and V-PEAK, which interpret and evaluate the change of volume and density of pulmonary nodule simultaneously from both exterior and interior perspectives, can help to distinguish IAC from PIA. ADVANCES IN KNOWLEDGE: This study provided researchers of GGN another perspective, taking both volume and density of nodules into consideration for pathological evaluation.

Three-dimensional vs two-dimensional video assisted thoracoscopic esophagectomy for patients with esophageal cancer.

AIM: To define the benefits of three-dimensional video-assisted thoracoscopic esophagectomy (3D-VATE) over 2D-VATE for esophageal cancer. METHODS: A total of 93 patients with esophageal cancer including 45 patients receiving 3D-VATE and 48 receiving 2D-VATE were evaluated. Data related to patient and cancer characteristics, operating time, intraoperative bleeding, morbidity and mortality, postoperative inflammatory markers, Numerical Rating Scale for postoperative pain, Constant-Murley rating system for shoulder recovery and oxygenation index (OI) were collected. All medical records were retrieved from a prospectively maintained oncological database at our institution. A retrospective study was performed to compare the short-term surgical outcomes between the two groups. RESULTS: No significant differences were found between the two groups in either morbidity or mortality (P = 0.328). An enhanced surgical recovery was noted in the 3D group as indicated by shortened thoracoscopic operation time (3D vs 2D: 68 ± 13.79 min vs 83 ± 13 min, P < 0.01), minor intraoperative blood loss (3D vs 2D: 68.2 ± 10.7 mL vs 89.8 ± 10.4 mL, P < 0.01), earlier chest tube removal (3D vs 2D: 2.67 ± 1.01 vs 3.75 ± 1.15 d, P < 0.01), shorter length of hospital stay (3D vs 2D: 9.07 ± 2.00 vs 10.85 ± 3.40 d, P < 0.01), lower in-hospital expenses (3D vs 2D: 74968.4 ± 9637.8 vs 86211.1 ± 8519.7 RMB, P < 0.01), lower pain intensity (P < 0.01) and faster recovery of the left shoulder function (P < 0.01). Better preservation of the pulmonary function was also found in the 3D group as the decline of the OI post operation was significantly lower than that of the 2D group (P < 0.01). Changes of postoperative inflammatory markers, including procalcitonin [postoperative days (PODs) 4 and 7: P < 0.01], peripheral granulocytes (PODs 1, 4 and 7: P < 0.01) and hypersensitive C-reactive protein (POD 4: P < 0.01) in 3D-VATE patients were less than those in the 2D group. Moreover, utilization of the 3D technique extended the dissection of the thoracic lymph nodes (P < 0.01), with better exposure of nodes in the left recurrent laryngeal nerve (P = 0.031). CONCLUSION: 3D-VATE could be a more viable technique over 2D-VATE in terms of short-term outcomes for patients with esophageal cancer.

Radiologic Predictors for Clinical Stage IA Lung Adenocarcinoma with Ground Glass Components: A Multi-Center Study of Long-Term Outcomes.

OBJECTIVE: This study was to define preoperative predictors from radiologic findings for the pathologic risk groups based on long-term surgical outcomes, in the aim to help guide individualized patient management. METHODS: We retrospectively reviewed 321 consecutive patients with clinical stage IA lung adenocarcinoma with ground glass component on computed tomography (CT) scanning. Pathologic diagnosis for resection specimens was based on the 2011 IASLC/ATS/ERS classification of lung adenocarcinoma. Patients were classified into different pathologic risk grading groups based on their lymph node status, local regional recurrence and overall survival. Radiologic characteristics of the pulmonary nodules were re-evaluated by reconstructed three-dimension CT (3D-CT). Univariate and multivariate analysis identifies independent radiologic predictors from tumor diameter, total volume (TV), average CT value (AVG), and solid-to-tumor (S/T) ratio. Receiver operating characteristic curves (ROC) studies were carried out to determine the cutoff value(s) for the predictor(s). Univariate cox regression model was used to determine the clinical significance of the above findings. RESULTS: A total of 321 patients with clinical stage IA lung adenocarcinoma with ground glass components were included in our study. Patients were classified into two pathologic low- and high- risk groups based on their distinguished surgical outcomes. A total of 134 patients fell into the low-risk group. Univariate and multivariate analyses identified AVG (HR: 32.210, 95% CI: 3.020-79.689, P<0.001) and S/T ratio (HR: 12.212, 95% CI: 5.441-27.408, P<0.001) as independent predictors for pathologic risk grading. ROC curves studies suggested the optimal cut-off values for AVG and S/T ratio were-198 (area under the curve [AUC] 0.921), 2.9 (AUC 0.996) and 54% (AUC 0.907), respectively. The tumor diameter and TV were excluded for the low AUCs (0.778 and 0.767). Both the cutoff values of AVG and S/T ratio were correlated with pathologic risk classification (p<0.001). Univariate Cox regression model identified clinical risk classification (RR: 3.011, 95%CI: 0.796-7.882, P = 0.095) as a good predictor for recurrence-free survival (RFS) in patients with clinical stage IA lung adenocarcinoma. Statistical significance of 5-year OS and RFS was noted among clinical low-, moderate- and high-risk groups (log-rank, p = 0.024 and 0.010). CONCLUSIONS: The AVG and the S/T ratio by reconstructed 3D-CT are important preoperative radiologic predictors for pathologic risk grading. The two cutoff values of AVG and S/T ratio are recommended in decision-making for patients with clinical stage IA lung adenocarcinoma with ground glass components.

Preoperative Prediction of Ki-67 Labeling Index By Three-dimensional CT Image Parameters for Differential Diagnosis Of Ground-Glass Opacity (GGO).

The aim of this study was to predict Ki-67 labeling index (LI) preoperatively by three-dimensional (3D) CT image parameters for pathologic assessment of GGO nodules. Diameter, total volume (TV), the maximum CT number (MAX), average CT number (AVG) and standard deviation of CT number within the whole GGO nodule (STD) were measured by 3D CT workstation. By detection of immunohistochemistry and Image Software Pro Plus 6.0, different Ki-67 LI were measured and statistically analyzed among preinvasive adenocarcinoma (PIA), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC). Receiver operating characteristic (ROC) curve, Spearman correlation analysis and multiple linear regression analysis with cross-validation were performed to further research a quantitative correlation between Ki-67 labeling index and radiological parameters. Diameter, TV, MAX, AVG and STD increased along with PIA, MIA and IAC significantly and consecutively. In the multiple linear regression model by a stepwise way, we obtained an equation: prediction of Ki-67 LI=0.022*STD+0.001* TV+2.137 (R=0.595, R's square=0.354, p<0.001), which can predict Ki-67 LI as a proliferative marker preoperatively. Diameter, TV, MAX, AVG and STD could discriminate pathologic categories of GGO nodules significantly. Ki-67 LI of early lung adenocarcinoma presenting GGO can be predicted by radiologic parameters based on 3D CT for differential diagnosis.