Prognostic implications of combining EGFR-TKIs and radiotherapy in Stage IV lung adenocarcinoma with 19-Del or 21-L858R mutations: A real-world study.

OBJECTIVE: To elucidate the potential benefits of combining radiotherapy and epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) for individuals with Stage IV lung adenocarcinoma (LUAD) harboring either exon 19 deletion (19-Del) or exon 21 L858R mutation (21-L858R). METHODS: In this real-world retrospective study, 177 individuals with Stage IV LUAD who underwent EGFR-TKIs and radiotherapy at Shandong Cancer Hospital from June 2012 to August 2017 were included. The main focus of this real-world study was overall survival (OS). RESULTS: The clinical characteristics of patients with Stage IV LUAD harboring 19-Del were similar to those harboring 21-L858R (p > 0.05). Overall, the patients had a median OS (mOS) of 32.0 months (95% confidence interval [CI]: 28.6-35.5). Subsequently, multivariate analysis indicated that both EGFR mutations and thoracic radiotherapy were independent predictors of OS (p = 0.001 and 0.013). Furthermore, subgroup analysis highlighted a longer OS for the 19-Del group compared to the 21-L858R group, especially when EGFR-TKIs were combined with bone metastasis or thoracic radiotherapy (mOS: 34.7 vs. 25.1 months and 51.0 vs. 29.6 months; p = 0.0056 and 0.0013, respectively). However, no significant differences were found in OS when considering patients who underwent brain metastasis radiotherapy (mOS: 34.7 vs. 25.1 months; p = 0.088). CONCLUSIONS: Patients with Stage IV LUAD harboring 19-Del experience a notably prolonged OS following combined therapy with EGFR-TKIs and radiotherapy, while this OS benefit is observed despite the absence of substantial differences in the clinical characteristics between the 19-Del and 21-L858R groups.

Ros-responsive nano-platform for lipid-specific fluorescence imaging of atherosclerosis.

Fluorescent probes that specifically targeting Lipid droplets (LDs) have shown potential in biological imaging. Albeit, their in vivo applications are limited due to the hydrophobicity, low signal-to-noise ratio (SNR) and LDs-specificity. Thus, we designed a novel probe namely MeOND, and a reactive oxygen species (ROS)-responsive nano-platform to improve in vivo LDs-specific imaging. MeOND exhibits a remarkable twisted intramolecular charge transfer (TICT) effect with a strongly enhanced near-infrared emission in low-polarity lipid environment. Also, MeOND demonstrates satisfactory biocompatibility and superior intracellular LDs imaging capabilities. MeOND encapsulated nano-platform (MeOND@PMM) presented favorable water solubility and biocompatibility. MeOND@PMM remains stable in physiological conditions but quickly degrades in the environment of elevated ROS level. The released MeOND could then light up the intracellular LDs in atherosclerotic plaques. The design of the probe and nano-platform is expected to provide a better tool for the scientific research of LDs and LDs-related diseases.

Supplementary Low Far-Red Light Promotes Proliferation and Photosynthetic Capacity of Blueberry In Vitro Plantlets.

Far-red light exerts an important regulatory influence on plant growth and development. However, the mechanisms underlying far-red light regulation of morphogenesis and photosynthetic characteristics in blueberry plantlets in vitro have remained elusive. Here, physiological and transcriptomic analyses were conducted on blueberry plantlets in vitro supplemented with far-red light. The results indicated that supplementation with low far-red light, such as 6 µmol m-2 s-1 and 14 µmol m-2 s-1 far-red (6FR and 14FR) light treatments, significantly increased proliferation-related indicators, including shoot length, shoot number, gibberellin A3, and trans-zeatin riboside content. It was found that 6FR and 14 FR significantly reduced chlorophyll content in blueberry plantlets but enhanced electron transport rates. Weighted correlation network analysis (WGCNA) showed the enrichment of iron ion-related genes in modules associated with photosynthesis. Genes such as NAC, ABCG11, GASA1, and Erf74 were significantly enriched within the proliferation-related module. Taken together, we conclude that low far-red light can promote the proliferative capacity of blueberry plantlets in vitro by affecting hormone pathways and the formation of secondary cell walls, concurrently regulating chlorophyll content and iron ion homeostasis to affect photosynthetic capacity.

Underdog entrepreneurship in the digital era: The effect of digital servitization on household entrepreneurship in China.

In today's digital era, households are empowered by digital servitization, which could potentially impact their ability to become entrepreneurs. Using data from the China Family Panel Studies (CFPS) and the National Bureau of Statistics of China, we construct the digital servitization index to analyze the impact of digital servitization on household entrepreneurship. The results show that the utilization of digital servitization by households significantly increases the likelihood of them engaging in entrepreneurial endeavors. This result remains robust after a series of robustness tests. We also find that digital servitization can help households identify entrepreneurial opportunities and access entrepreneurial resources by alleviating information and financial constraints, and increasing social capital. Further, the effect is more among households with rural residences, low material assets, elderly household heads, and household heads with low cognitive abilities, which means that digital servitization can promote underdog entrepreneurship. In conclusion, this paper provides micro-level evidence supporting the idea that digital servitization can foster household entrepreneurship, particularly among underprivileged groups. Ultimately, this paper highlights the potential of digitization as an essential resource to drive economic growth and help households in need become successful entrepreneurs.

Handcrafted silver substrates boost surface plasmon resonance for ultra-sensitive lipid analysis.

Lipid monitoring plays a crucial role in biomedical research, particularly in the areas of cardiovascular health, metabolic disorders and nutrition. However, direct and highly sensitive detection of lipids poses significant challenges due to the interference of high SERS background noise in lipid samples. In this study, we present a SERS platform for the quantitative analysis of lipids. By harnessing the Surface Plasmon Resonance (SPR) effect of nanostructured grooves and leveraging deuterium oxide, a remarkable enhancement of in-situ Raman signals originating from cholesterol is achieved. This approach yielded an impressive average enhancement factor of 7.3 × 105 and a detection limit of 1.9 × 10-4 mg/mL, highlighting the exceptional sensitivity and precision of our method. We have obtained high quality, in-situ SERS signals for six distinct lipid molecules. Rapid identification of lipid samples in mixed systems has been achieved through the combination of characteristic peak analysis and PCA-LDA, including the detection of SERS signals from lipids in milk. Notably, univariate monitoring of in-situ cholesterol in human serum was successfully achieved for the first time using deuterium water as an internal standard. In addition, silver substrate demonstrated outstanding reproducibility, maintaining consistent SERS activity even after more than 10 repetitions. Therefore, this platform offers the distinct advantages of high sensitivity, specificity and cost-effectiveness for lipid detection. These findings enable dietary management and blood lipid monitoring, and therefore hold crucial implications for the early prevention of lipid-related disorders and diseases.

Polyethylene glycol with dual three-dimensional porous carbon nanotube/diamond: a high thermal conductivity of composite PCM.

Polyethylene glycol (PEG) is widely used as a phase change material (PCM) in thermal energy storage systems due to its high latent heat and chemical stability. However, practical application has been hindered by its low thermal conductivity and leakage issues. Therefore, developing shape-stable high thermal conductivity PCM is of great importance. In this study, new shape-stable composite PCM with high thermal conductivity and leak-prevention capabilities were designed. The porous carbon skeleton of diamond foam (DF) and dual-3D carbon nanotube-diamond foam (CDF) were prepared using the microwave plasma chemical vapor deposition method. The composite materials (DF/PEG and CDF/PEG) were produced by vacuum impregnation with PEG and skeletons. The results showed that CDF/PEG had the highest thermal conductivity, measuring 2.30 W·m-1·K-1, which is 707% higher than that of pure PEG. The employing of 3D networks of CNTs, which can improve the phonon mean free path in DF/PEG (1.79 W·m-1·K-1) while reducing phonon dispersion.The phonon vibration of dual-3D CDF plays an important role in heat transfer. PEG was physically absorbed and well-distributed in CDF, alleviating leakage of liquid PEG. The weight loss of CDF/PEG was only 25% at 70 °C for 120 s. Using CDF is an attractive and efficient strategy to increase the heat transfer of PEG and improve heat storage efficiency, alleviate the problem of poor shape-stability.

Multifunctional Asymmetric Separator Constructed by Polyacrylonitrile-Derived Nanofibers for Lithium-Sulfur Batteries.

Lithium-sulfur (Li-S) batteries hold great promise as next-generation high-energy storage devices owing to the high theoretical specific capacity of sulfur, but polysulfide shuttling and lithium dendrite growth remain key challenges limiting cycling life. In this work, we propose a polyacrylonitrile-derived asymmetric (PDA) separator to enhance Li-S battery performance by accelerating sulfur redox kinetics and guiding lithium plating and stripping. A PDA separator was constructed from two layers: the cathode-facing side consists of polyacrylonitrile nanofibers carbonized at 800 °C and doped with titanium nitride, which can achieve rapid polysulfide conversion via electrocatalysis to suppress their shuttling; the anode-facing side consists of polyacrylonitrile oxidized at 280 °C, on which the abundant electronegative groups guide uniform lithium ion plating and stripping. Li-S batteries assembled with the PDA separator exhibited enhanced rate performance, cycling stability, and sulfur utilization, retaining 426 mA h g-1 capacity at 1 C over 1000 cycles and 632 mA h g-1 at 4 C over 200 cycles. Attractively, the PDA separator showed high thermal stability, which could mitigate the risk of internal short circuits and thermal runaway. This work demonstrates an original path to addressing the most critical issues with Li-S batteries.

The prognostic biological markers of immunotherapy for non-small cell lung cancer: current landscape and future perspective.

The emergence of immunotherapy, particularly programmed cell death 1 (PD-1) and programmed cell death ligand-1 (PD-L1) produced profound transformations for treating non-small cell lung cancer (NSCLC). Nevertheless, not all NSCLC patients can benefit from immunotherapy in clinical practice. In addition to limited response rates, exorbitant treatment costs, and the substantial threats involved with immune-related adverse events, the intricate interplay between long-term survival outcomes and early disease progression, including early immune hyperprogression, remains unclear. Consequently, there is an urgent imperative to identify robust predictive and prognostic biological markers, which not only possess the potential to accurately forecast the therapeutic efficacy of immunotherapy in NSCLC but also facilitate the identification of patient subgroups amenable to personalized treatment approaches. Furthermore, this advancement in patient stratification based on certain biological markers can also provide invaluable support for the management of immunotherapy in NSCLC patients. Hence, in this review, we comprehensively examine the current landscape of individual biological markers, including PD-L1 expression, tumor mutational burden, hematological biological markers, and gene mutations, while also exploring the potential of combined biological markers encompassing radiological and radiomic markers, as well as prediction models that have the potential to better predict responders to immunotherapy in NSCLC with an emphasis on some directions that warrant further investigation which can also deepen the understanding of clinicians and provide a reference for clinical practice.

Mechanistic insights into the leaching and environmental safety of arsenic in ceramsite prepared from fly ash.

Utilizing fly ash to prepare ceramsite is a promising way to immobilize heavy metals and recycle industrial solid waste. However, traditional preparation method of fly ash ceramsite has the disadvantages of large ignition loss. Therefore, the present study applied the pressure molding method to enhance solid content and improve the strength of ceramsite. The optimal preparation conditions of ceramsite were suggested as preheating at 450 °C for 25 min followed by sintering at 1050 °C for 30 min. Under such conditions, ceramsite with high compressive strength of 10.8 Mpa, bulk density of 878 kg m-3, and 1-h water absorption of 18.5% was fabricated, in compliance with Chinese standard (GB/T 1743.1-2010). The arsenic leaching concentration from the resulting product was considerably lower than Chinese standard (GB 5085.3-2007). Moreover, arsenic volatilization during ceramsite calcination was insignificant, and the vast majority of arsenic remained in resulting ceramsite. A geochemical speciation model developed for the multiple component system in ceramsite suggested that FeAsO4, Ca5(OH) (AsO4)3, and hydrous ferric oxide adsorption are the primary mechanisms retaining arsenic in ceramsite. Additionally, based on density functional theory calculations and biotoxicity test, the binding site of arsenic atom on mineral components and the environmental safety of ceramsite was determined and evaluated.

Role of BraRGL1 in regulation of Brassica rapa bolting and flowering.

Gibberellin (GA) plays a major role in controlling Brassica rapa stalk development. As an essential negative regulator of GA signal transduction, DELLA proteins may exert significant effects on stalk development. However, the regulatory mechanisms underlying this regulation remain unclear. In this study, we report highly efficient and inheritable mutagenesis using the CRISPR/Cas9 gene editing system in BraPDS (phytoene desaturase) and BraRGL1 (key DELLA protein) genes. We observed a loss-of-function mutation in BraRGL1 due to two amino acids in GRAS domain. The flower bud differentiation and bolting time of BraRGL1 mutants were significantly advanced. The expression of GA-regulatory protein (BraGASA6), flowering related genes (BraSOC1, BraLFY), expansion protein (BraEXPA11) and xyloglucan endotransferase (BraXTH3) genes was also significantly upregulated in these mutants. BraRGL1-overexpressing plants displayed the contrasting phenotypes. BraRGL1 mutants were more sensitive to GA signaling. BraRGL1 interacted with BraSOC1, and the interaction intensity decreased after GA3 treatment. In addition, BraRGL1 inhibited the transcription-activation ability of BraSOC1 for BraXTH3 and BraLFY genes, but the presence of GA3 enhanced the activation ability of BraSOC1, suggesting that the BraRGL1-BraSOC1 module regulates bolting and flowering of B. rapa through GA signal transduction. Thus, we hypothesized that BraRGL1 is degraded, and BraSOC1 is released in the presence of GA3, which promotes the expression of BraXTH3 and BraLFY, thereby inducing stalk development in B. rapa. Further, the BraRGL1-M mutant promoted the flower bud differentiation without affecting the stalk quality. Thus, BraRGL1 can serve as a valuable target for the molecular breeding of early maturing varieties.

Progress in the Treatment of High Altitude Cerebral Edema: Targeting REDOX Homeostasis.

With the increasing of altitude activities from low-altitude people, the study of high altitude cerebral edema (HACE) has been revived. HACE is a severe acute mountain sickness associated with exposure to hypobaric hypoxia at high altitude, often characterized by disturbance of consciousness and ataxia. As for the pathogenesis of HACE, previous studies suggested that it might be related to the disorder of cerebral blood flow, the destruction of blood-brain barrier and the injury of brain parenchyma cells caused by inflammatory factors. In recent years, studies have confirmed that the imbalance of REDOX homeostasis is also involved in the pathogenesis of HACE, which mainly leads to abnormal activation of microglia and destruction of tight junction of vascular endothelial cells through the excessive production of mitochondrial-related reactive oxygen species. Therefore, this review summarizes the role of REDOX homeostasis and the potential of the treatment of REDOX homeostasis in HACE, which is of great significance to expand the understanding of the pathogenesis of HACE. Moreover, it will also be helpful to further study the possible therapy of HACE related to the key link of REDOX homeostasis.

Bibliometric and visualized analysis of drug resistance in ovarian cancer from 2013 to 2022.

Objective: As one of the cancers that seriously threatens women's health, ovarian cancer has a high morbidity and mortality rate. Surgery and chemotherapy are the basic treatment strategies for ovarian cancer, and chemotherapy resistance is a significant factor in affecting the prognosis, survival cycle, and recurrence of ovarian cancer. This article aims to analyze articles about ovarian cancer and drug resistance via bibliometric software, offering new ideas and directions for researchers in this field. Methods: Both Citespace and Vosviewer are bibliometric software on the Java platform. Articles were collected on ovarian cancer and drug resistance in the Web of Science Core Collection database from 2013 to 2022. The countries, institutions, journals, authors, keywords, and references were analyzed, and the development status of this field was indicated from multiple perspectives. Results: Studies on ovarian cancer and drug resistance generally showed an increasing trend from 2013 to 2022. The People's Republic of China and Chinese institutions contributed more to this field. Gynecologic Oncology published the most articles, and the journal with the most citations was Cancer Research. Li Li was the author with the most publications, and Siegel RL was the author with the most citations. Through burst detection, it can be found that the research hotspots in this field mainly focused on the in-depth exploration of the drug resistance mechanism of ovarian cancer and the progress of PARP inhibitors and bevacizumab in the treatment of ovarian cancer. Conclusions: Many studies on the mechanism of drug resistance in ovarian cancer have been discovered; however, the deeper mechanism remains to be explored. Compared with traditional chemotherapy drugs, PARP inhibitors and bevacizumab have shown better efficacy, but PARP inhibitors have initially shown drug resistance. The future direction of this field should be to overcome the resistance of existing drugs and actively develop new ones.

Corrigendum: Bibliometric and visualized analysis of drug resistance in ovarian cancer from 2013 to 2022.

[This corrects the article DOI: 10.3389/fonc.2023.1173863.].

A turn-on fluorescent probe for lipid-targeting imaging in human arterial aneurysm and fibrocalcific stenotic aortic valve.

Fluorescence imaging techniques have shown remarkable performance in studying the biological functions of lipid droplets (LDs). However, the biological applications of the commercially available LDs probes suffer from insufficient specificity and low signal/noise ratio (SNR). Herein, we presented a novel near-infrared (NIR) lipid activatable fluorescence probe, namely Me2NND, with extremely low emission in water but significantly enhanced emission in the lipid environment. Me2NND presented good biocompatibility and impressive LDs-specific imaging ability in cells and tissues. Moreover, Me2NND has also shown good photostability and it could efficiently locate the distribution of LDs in human pathological samples of aortic aneurysms and fibrocalcific stenotic aortic valves. This study provided a novel turn-on probe Me2NND and would improve the bio-applications of LDs-specific probes.

Precise diagnosis and successful surgical intervention of the median arcuate ligament syndrome: A case report.

INTRODUCTION AND IMPORTANCE: The median arcuate ligament syndrome (MALS) is a rare disorder that produces a spectrum of symptoms due to compression of the arcuate ligament, clinically manifested primarily by abdominal pain, nausea, vomiting, and weight loss. The mechanism of these symptoms has not yet been revealed, and the current treatment methods are still somewhat controversial. CASE PRESENTATION: We present a 54-year-old woman who presented with intermittent epigastric pain for nine months. During the onset, she lost 7.5 kg. After routine examinations in a nearby hospital, no abnormality was found. She was referred to us. CTA showed compression of the celiac artery. Further selective celiac angiography at the end of inspiration and expiration confirmed MALS. After consultation with the patient, the decision to have a laparotomy was made. The celiac artery was completely skeletonized, and external compression on the artery was released. Postoperative symptoms improved significantly. One-year follow-up after the operation, she had a weight gain of 4.8 kg and was satisfied with the surgical results. CLINICAL DISCUSSION: The manifestations of MALS are varied and challenging. Our patient presented with weight loss and intermittent abdominal pain. The mutual confirmation of multiple investigations can provide a more comprehensive overview of celiac artery compression. We confirmed using ultrasonography, CT angiography, and selective digital subtraction angiography in this case. The celiac artery compression was relieved after open surgery. Our patient's symptoms improved significantly after surgery. We hope our treatment method can provide a reference for MALS diagnosis and treatment. CONCLUSION: It is challenging to diagnose MALS. Cross-confirmation of multiple examinations can provide a more comprehensive view of celiac compression. Surgical decompression of the celiac artery (open or laparoscopic surgery) may be an effective therapy for MALS, especially in centers with experience.

Universal Method for Label-Free Detection of Pathogens and Biomolecules by Surface-Enhanced Raman Spectroscopy Based on Gold Nanoparticles.

The detection of biomolecules is the key to basic molecular research, diagnostics, drug screening, and other biomedical applications. However, the existing detection techniques can only detect single classes of biomolecules, which warrant the development of a versatile biomolecule detection platform. Here, we developed a universal method for label-free detection of biomolecules via surface-enhanced Raman spectroscopy (SERS) by using sulfhydryl-modified gold nanoparticles as the substrate. The biomolecules can be adsorbed on the surface of gold nanoparticles cleaned by bromide ions to obtain initially enhanced Raman signals, and the aggregator (calcium ion) was further added to form a "hot spot", which enhanced the biomolecular signal again. Through the "two-step enhancement method", we were able to obtain fingerprints of DNA, RNA, amino acids, peptides, proteins, viruses, bacteria, and lipid molecules. This low-toxic, highly sensitive, and widely applicable technique has potential applications in biomedical research, clinical testing, and disease diagnosis and lays the foundation for the development of SERS technology in various fields.

Aggregation-induced bioprobe for plasma membrane-specific imaging and photodynamic cancer cell ablation.

Selective labelling of the plasma membrane (PM) by fluorescence imaging techniques enables an intuitive analysis of cell status together with dynamic changes, and therefore is of great value. We herein disclose a novel carbazole-based probe, CPPPy, that shows aggregation-induced emission (AIE) property and is observed to selectively accumulate at the PM of living cells. Benefiting from its good biocompatibility and PM-targeted specificity, CPPPy can light up the PM of cells by high-resolution imaging even at a low concentration of 200 nM. Simultaneously, CPPPy is capable of generating both singlet oxygen and free radical-dominated species upon visible light irradiation, which further induces irreversible growth inhibition and necrocytosis of tumor cells. This study thus provides new insight into the construction of multifunctional fluorescence probes with PM-specific bioimaging and photodynamic therapy.

Immobilization of heavy metals in ceramsite prepared using contaminated soils: Effectiveness and potential mechanisms.

Heavy metal contaminated soils pose a serious threat to the environment, and preparing ceramsite using contaminated soils was proposed as an effective method to address this threat in this study. Specifically, two typical soils (i.e., contaminated clay and sandy soil) were mixed with different ratios and calcined at temperature 1000-1200 °C to prepare ceramsite. Special attentions were paid to evaluating the immobilization of heavy metals in ceramsite and identifying the corresponding immobilization mechanisms. Using the leachability of heavy metals from ceramsite as evaluation criteria, the optimum mixing ratio of clay/sandy soil and sintering temperature were determined as 0.6:0.4 and 1200 °C. Moreover, based on the spectroscopic characterizations and thermodynamic calculation, high sintering temperature well facilitated the liquid phases formation, promoting the reactions between heavy metals and aluminosilicates and the valence state conversion of heavy metals. Accordingly, heavy metals were well immobilized in ceramsite by forming thermodynamically stable minerals, being encapsulated in solid matrix, and transforming to valence states with low mobility. The leaching conditions including pH and temperature had minimal effect on the immobilization of heavy metals in ceramsite. In summary, ceramsite prepared by contaminated soils was environmentally friendly and had good potential in engineering application as building materials.

Aggregation-induced emission fluorescent probes for lipid droplets-specific bioimaging of cells and atherosclerosis plaques.

Visualizing lipid droplets (LDs) using fluorescence imaging is highly desirable for the diagnosis and treatment of atherosclerotic heart diseases. However, the imaging performance of the current commercial lipid probes is unsatisfactory. In this study, we prepared two probes (TTM and MeO-TTM) with aggregation-induced emission (AIE) properties for LD imaging with efficiency. Interestingly, TTM and MeO-TTM showed low emissions in H2O but their emissions were significantly increased in oil. Moreover, TTM and MeO-TTM showed great biocompatibility and intracellular LDs would be specifically illuminated by these probes with good resistance to photobleaching. In addition, TTM and MeO-TTM also exhibited great imaging performance in studying the spatial distribution of LDs in mouse atherosclerotic plaques. This work not only provides a simple tool for studying atherosclerosis but also hopes to enhance the development of fluorescent probes for LDs-specific imaging applications.

Cardiac Substructures Dosimetric Predictors for Cardiac Toxicity After Definitive Radiotherapy in Esophageal Cancer.

PURPOSE: To investigate the predictive value of the cardiac substructures (CSs) dosimetric parameters for cardiac toxicity after definitive radiation therapy in locally advanced esophageal cancer. METHODS AND MATERIALS: Between August 2010 and January 2016, 716 patients with stage 2-3 esophageal cancer receiving definitive radiation therapy at 2 institutions were divided into training (n = 432) and external validation (n = 284) cohorts. Dose-volume histogram parameters for the whole heart (WH) and CSs were extracted. Competing risks and Cox regressions analyses were performed. The predictive performance of the models was evaluated using the area under the receiver operating characteristic curve (AUC) and the Brier score. RESULTS: With a median follow-up of 93 months, 68 patients (15.7%) developed grade ≥3 cardiac events (G3+ CEs), with a median of 13.5 months to the first event. Multivariable analysis showed left ventricle, left anterior descending (LAD), and mean left circumflex (LCX) variables were significantly associated with G3+ CEs. The AUCs and Brier scores demonstrated favorable predictive accuracies of the models integrating these CS variables when predicting G3+ CEs in the training and validation cohorts. However, compared with the WH variables, the CS variables did not significantly improve the prediction of G3+ CEs. Nevertheless, when G3+ acute coronary syndrome and/or congestive heart failure (ACS/CHF) CE was the outcome of interest, models based on the LAD or LCX variables were superior to the WH variable models in training and validation cohorts. CONCLUSIONS: Models based on CS variables showed favorable predictive accuracy for G3+ CEs. The LAD and LCX variables significantly improved the prediction of G3+ ACS/CHF events compared with the WH variables. Radiation doses to CSs, such as LCX and LAD, should be monitored to help reduce the occurrence of significant CEs in patients with esophageal cancer undergoing definitive radiation therapy.