Prediction of SBRT response in liver cancer by combining original and delta cone-beam CT radiomics: a pilot study.

This study aims to explore the feasibility of utilizing a combination of original and delta cone-beam CT (CBCT) radiomics for predicting treatment response in liver tumors undergoing stereotactic body radiation therapy (SBRT). A total of 49 patients are included in this study, with 36 receiving 5-fraction SBRT, 3 receiving 4-fraction SBRT, and 10 receiving 3-fraction SBRT. The CBCT and planning CT images from liver cancer patients who underwent SBRT are collected to extract overall 547 radiomics features. The CBCT features which are reproducible and interchangeable with pCT are selected for modeling analysis. The delta features between fractions are calculated to depict tumor change. The patients with 4-fraction SBRT are only used for screening robust features. In patients receiving 5-fraction SBRT, the predictive ability of both original and delta CBCT features for two-level treatment response (local efficacy vs. local non-efficacy; complete response (CR) vs. partial response (PR)) is assessed by utilizing multivariable logistic regression with leave-one-out cross-validation. Additionally, univariate analysis is conducted to validate the capability of CBCT features in identifying local efficacy in patients receiving 3-fraction SBRT. In patients receiving 5-fraction SBRT, the combined models incorporating original and delta CBCT radiomics features demonstrate higher area under the curve (AUC) values compared to models using either original or delta features alone for both classification tasks. The AUC values for predicting local efficacy vs. local non-efficacy are 0.58 for original features, 0.82 for delta features, and 0.90 for combined features. For distinguishing PR from CR, the respective AUC values for original, delta and combined features are 0.79, 0.80, and 0.89. In patients receiving 3-fraction SBRT, eight valuable CBCT radiomics features are identified for predicting local efficacy. The combination of original and delta radiomics derived from fractionated CBCT images in liver cancer patients undergoing SBRT shows promise in providing comprehensive information for predicting treatment response.

Artemis as Predictive Biomarker of Responsiveness to Preoperative Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer.

The aim of this study was to identify Artemis as a predictive biomarker for guiding preoperative chemoradiotherapy in locally advanced rectal cancer. The resection specimens were collected from 50 patients with rectal cancer who underwent preoperative chemoradiotherapy. Artemis expression in biopsy tissues was evaluated using immunohistochemical staining according to the percentage of positively stained cells combined with staining intensity. Among the 50 patients, 36 (72%) had a weakly positive Artemis protein expression, 10 (20%) had a moderately positive expression, and 4 (8%) showed a strongly positive expression. The criteria of magnetic resonance imaging tumor regression grade (mrTRG) and pathological rectal cancer regression grade (RCRG) were used to assess the tumor response to chemoradiotherapy. Correlation analysis shows that there is a significant negative correlation between high Artemis immunoscore and treatment response (r = -0.532, p < 0.001). The results imply that high Artemis expression was associated with poor treatment response. Our study suggested a potential role of Artemis as a predictive biomarker of the tumor response to preoperative chemoradiotherapy in patients with locally advanced rectal cancer.

Inflammation index predicts radiation-induced lung injury and prognosis in lung tumors treated with stereotactic body radiation therapy.

PURPOSE: To investigate the effect of inflammation-based indexes in predicting radiation pneumonitis (RP) and prognosis in lung tumor patients treated with stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS: The data of one hundred and seventy-two patients with 272 lung lesions from November 2015 to December 2020 were retrospectively analyzed. Pretreatment hematological indexes including platelet count, neutrophil count, and lymphocyte count were collected before treatment. Systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were calculated. The receiver operating characteristic (ROC) curve was established to predict the RP and overall survival of patients, and the Youden index was calculated to determine the cutoff values of SII, NLR, and PLR before radiotherapy. RESULTS: Pretreatment SII, NLR, and PLR could predict RP in lung tumor patients treated with SBRT, the optimal cutoff values of SII, NLR, and PLR were 355.38, 2.04, and 141.09, respectively. Pretreatment PLR could predict survival and the optimal cutoff value of PLR was 166.83, patients with a PLR > 166.83 predict worse overall survival (OS) (P < 0.001). The 1-year and 2-year OS for patients with a PLR ≤ 166.83 were 96.3% and 82.4%, while for those with a PLR > 166.83 were 82.0% and 58.5%, respectively. CONCLUSION: In lung tumor patients treated with SBRT, pretreatment SII, NLR, and PLR can effectively predict RP and a higher PLR predicts poor OS. These inflammation-based indexes could serve as reliable and convenient predictors to guide treatment for physicians in clinical practice.

Efficient CO2 Electroreduction via Au-Complex Derived Carbon Nanotube Supported Au Nanoclusters.

The production of value-added chemicals from CO2 electroreduction, using renewable energy, provides an appealing route to achieve the goal of carbon neutrality. Challenges remain in designing and understanding of high-performance catalysts with restructuring behavior under electrochemical conditions. Here, the intrinsic performance enhancement of an Au-complex derived carbon nanotube-supported Au nanoclusters catalyst was demonstrated for CO2 reduction. This catalyst exhibited impressive activity for yielding CO in both H-cell and flow cell reactors. Experimental results revealed that the synthesis procedure via metal complex reconstructing on proper support induced charge transfer between Au nanoclusters and carbon nanotubes, forming a rather electron-rich state for Au active sites, which greatly contributed to the CO2 activation pathway.

Prognostic value of CEA and CA19-9 in patients with local advanced rectal cancer receiving neoadjuvant chemoradiotherapy, radical surgery and postoperative chemotherapy.

BACKGROUND: We aim to investigate the prognostic factors and evaluate the role of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in local advanced rectal cancer (LARC) patients who received neoadjuvant chemoradiotherapy (neo-CRT), radical surgery and postoperative chemotherapy. METHODS: In total, 197 cases of LARC patients who underwent neo-CRT, total mesorectal excision (TME), and adjuvant chemotherapy were recruited. Serum levels of CEA and CA19-9 were detected both at baseline and after neo-chemoradiotherapy. Multivariate analysis was used to assess correlations between levels of CEA and CA19-9 and patients' prognosis (survival, recurrence, and metastasis). Rates of survival, distant metastasis (DM), and local recurrence (LR) were estimated using Kaplan-Meier survival analysis, the log-rank test, and Cox proportional hazards. RESULTS: The median follow-up time was 45.3 months, and a cohort of 197 patients was analyzed; 84 (42.6%) patients had elevated baseline CEA levels, 21 (10.7%) patients had elevated baseline CA19-9 levels, and 14 (7.1%) patients had both; 77.4% (65/84) patients with high CEA levels and 76.2% (16/21) with high CA19-9 levels returned to normal after neo-chemoradiotherapy. The Cox regression model suggested that elevated CEA was associated with an increased risk of disease-free survival (DFS) (HR: 2.058, 95% CI: 1.034-4.096, P=0.040) and DM (HR: 2.144, 95% CI: 1.058-4.346, P=0.034). Elevated CA19-9 was identified as an independent prognostic factor, with poorer overall survival (OS) (HR: 2.894, 95% CI: 1.196-7.006, P=0.018) and DFS (HR: 4.533, 95% CI: 2.067-9.940, P<0.001) and increased incidences of LR (HR: 6.139, 95% CI: 1.813-20.783, P=0.004) and DM (HR: 4.052, 95% CI: 1.892-8.678, P<0.001). Besides, combined CEA with CA19-9 was a stronger prognostic predictor. Patients with both high levels of CEA and CA19-9 had the poorest DFS (HR: 8.157, 95% CI: 3.232-20.591, P<0.001) and the highest risk of DM (HR: 8.790, 95% CI: 3.324-23.248, P<0.001). CONCLUSIONS: LARC patients with high levels of CEA or/and CA19-9 at initial treatment have a worse prognosis, even after neo-CRT, subsequent radical resection, and adjuvant chemotherapy. These findings suggest that this subset of patients requires more intensive treatment or additional treatment strategies.

Highly Selective Electrocatalytic Reduction of CO2 into Methane on Cu-Bi Nanoalloys.

Methane (CH4), the main component of natural gas, is one of the most valuable products facilitating energy storage via electricity conversion. However, the poor selectivity and high overpotential for CH4 formation with metallic Cu catalysts prevent realistic applications. Introducing a second element to tune the electronic state of Cu has been widely used as an effective method to improve catalytic performance, but achieving high selectivity and activity toward CH4 remains challenging. Here, we successfully synthesized Cu-Bi NPs, which exhibit a CH4 Faradaic efficiency (FE) as high as 70.6% at -1.2 V versus reversible hydrogen electrode (RHE). The FE of Cu-Bi NPs has increased by approximately 25-fold compared with that of Cu NPs. DFT calculations showed that alloying Cu with Bi significantly decreases the formation energy of *COH formation, the rate-determining step, which explains the improved performance. Further analysis showed that Cu that has been partially oxidized because of electron withdrawal by Bi is the most possible active site.

Prognostic factors and patterns of recurrence after curative resection for patients with distal cholangiocarcinoma.

BACKGROUND AND PURPOSE: This study aimed to determine the prognostic factors and generate an atlas of a distribution of locoregional recurrence (LRR) in patients with distal cholangiocarcinoma (DCCA), after pancreatoduodenectomy (PD) without adjuvant radiotherapy. MATERIALS AND METHODS: 124 DCCA cases registered in our institutional database from 2006 to 2018 were analyzed retrospectively. The Cox proportional hazards model was used for multivariable analysis. All recurrence sites were centrally reviewed, and LRRs were plotted on one CT scan of a template that represents the relapse pattern of the patients. RESULTS: The median follow-up time was 35.3 months (95% CI 22.1-48.5 months). Independent prognostic factor for locoregional recurrence-free survival was lymph node metastasis (p = 0.014). Older age, pancreas invasion, and lymph node metastasis were associated with poor survival (both p < 0.05). During the follow-up period, 69 patients (55.6%) developed disease progression. Among them, 45 patients (65.2%) had recurrence in the locoregional components. 21 patients (30.4%) were diagnosed with liver metastasis. Of the patients with LRR, most recurrences occurred in the nodes along the superior mesenteric artery (36.2%), nodes around the abdominal aorta (26.1%), nodes in the hepatoduodenal ligament (13.0%), nodes around the celiac artery (10.1%), and anastomotic stoma (10.1%). CONCLUSION: The high-risk sites of LRR after PD for primary DCCA are the nodes along the superior mesenteric artery, abdominal aorta, nodes in the hepatoduodenal ligament, nodes around the celiac artery, and anastomotic stoma. Adjuvant radiation should cover these areas to improve locoregional control for these patients.

Neutrophil-lymphocyte ratio as a prognostic factor for stereotactic body radiotherapy treatment of metastatic liver tumors.

BACKGROUND: The neutrophil-lymphocyte ratio (NLR) has been proposed as an indicator of systemic inflammatory response and may be able to predict clinical outcomes in patients with malignant solid tumors. However, the relationship between NLR and the prognosis of liver metastasis after stereotactic body radiotherapy (SBRT) is not well established. METHODS: Patients with liver metastatic tumors who underwent SBRT in our center between 2015 and 2018 were enrolled, and their data were retrospectively analyzed. The patient' baseline total white blood cell (WBC), neutrophil, lymphocyte, and platelet counts were recorded, along with their mean platelet volume (MPV) and red blood cell distribution width (RDW). The cut-off values for NLR and platelet-lymphocyte ratio (PLR) were determined by receiver operating characteristic (ROC) curves. Local control (LC) and overall survival (OS) were calculated using the Kaplan-Meier method. The Cox proportional hazards model was used to study significant variable line and factors associated with OS. RESULTS: A total of 65 patients with 82 lesions were enrolled. The median duration follow-up was 21 months. The local control (LC) rate was 76.8%, and the 1- and 2-year OS rates were 70.7% and 46.1%, respectively. The cut-off values of NLR and PLR were 3.16 and 201.33, respectively. Multivariate analysis identified the NLR cut-off value as a potential independent indicator of inferior OS [P=0.005, HR =3.317 (95% CI, 1.433-7.678)]. Biological effective dose (BED) was also associated with OS (P=0.035, HR =0.984 (95% CI, 0.969-0.999)]. CONCLUSIONS: NLR showed a strong association with LC and OS, which could serve as a predictive guide in the treatment of liver metastasis with SRBT. BED is also an independent factor affecting OS.

Comparison of Energy-Based Tissue Dissection Techniques in Abdominoplasty: A Randomized, Open-Label Study Including Economic Aspects.

BACKGROUND: Abdominoplasty is one of the most common procedures in plastic surgery, and energy-based tissue dissection techniques have become the gold standard. Despite its frequency, abdominoplasty is still associated with high complication rates. OBJECTIVES: The authors compared clinical and economic data of 4 methods of energy-based tissue dissection in a randomized, open-label study. METHODS: A total of 57 patients were preoperatively randomized into 4 groups: electrocautery, Ultracision Harmonic Scalpel, argon plasma coagulation, and PEAK-Plasmablade. Demographic and operational data as well as information on the postoperative course and complications were collected. For economic analysis, quotes were obtained from the device companies or official suppliers. RESULTS: Duration of surgery, drainage quantity, and wound healing complications did not differ significantly between groups. The Ultracision method caused significantly greater blood loss compared with all other techniques (P < 0.01). PEAK and Ultracision devices entailed greater surgical costs compared with APC and electrocautery. CONCLUSIONS: All methods evaluated can be applied safely and effectively in abdominoplasty procedures. However, these data demonstrate a significantly higher blood loss for the Ultracision Harmonic Scalpel. Considering the clinical data, the higher costs of PEAK and Ultracision methods appear unjustified.

Concurrent Chemoradiotherapy in Curatively Resected Gallbladder Carcinoma: A Propensity Score-Matched Analysis.

PURPOSE: To compare overall survival (OS) between patients receiving radical resection followed by concurrent chemoradiotherapy (S+CCRT) and patients receiving radical resection only (S) for advanced resectable gallbladder carcinoma (GBC). METHODS AND MATERIALS: Ninety-four GBC patients with stage pT2-4, N0-1, and M0 consented to inclusion in a clinical database from June 2003 to July 2013. Patients who received S+CCRT were matched by propensity score with those who received S through nearest-neighbor matching, with a caliper width of 0.2 to ensure similar baseline characteristics between each group. The effects of CCRT on OS and disease-free survival (DFS) were evaluated with Kaplan-Meier analysis. Cox proportional hazards regression was performed on the entire cohort. Adverse effects and oncologic outcomes were assessed. RESULTS: Seventy-eight patients with GBC (39 S+CCRT; 39 S) were matched according to propensity score; the 1-year, 3-year, and 5-year OS was 74.4%, 56.4%, and 42.4% for the S+CCRT group and 51.3%, 30.8%, and 17.9% for the S group. The median survival time was 27 months (interquartile range [IQR], 12-58 months) for the S+CCRT group versus 13 months (IQR, 5-30 months) for the S group (P=.004), with the 1-year and 3-year DFS being 59.0% versus 35.9% and 48.7% versus 13.5%, respectively, and the median DFS being 23 months (IQR, 8-57 months) versus 7 months (IQR, 4-23 months) (P=.004). CONCLUSIONS: The OS of matched patients with stage II-IVA GBC is significantly improved by CCRT. Radiation therapy combined with single-agent or dual-agent chemotherapy was feasible and well tolerated.