Risk of second primary thyroid cancer in cancer survivors.

A risk factor for thyroid cancer (TC) may be a history of former cancer and cancer therapy. The precise risk of a second primary thyroid carcinoma has not yet been revealed. In this study, we evaluated standardized incidence ratios (SIRs) of second primary thyroid cancer (SPTC) with consideration of different conditions and further analyzed the clinicopathological characteristics and survival of these patients. The cohort was selected from the US Surveillance, Epidemiology, and End Results (SEER) Program between 1975 and 2019. The standardized incidence ratios, morbidity risk, clinicopathological features, and survival of second primary thyroid carcinoma were analyzed. Propensity score matching (PSM) was used to balance covariates. Kaplan-Meier method was performed to assess the survival outcomes. Overall, 7066 patients with SPTC and 83,113 patients with primary TC were identified. The SIR of TC in tumor patients was 1.51/10,000, statistically higher than the natural population (0.94/10,000, P < 0.05). The most significant tumors contributing to the increased SIRs of SPTC were acute lymphocytic leukemia (3.49/10,000), Hodgkin's lymphoma-nodal (3.29/10,000), salivary gland cancer (3.23/10,000), and kidney and renal pelvis cancer (3.05/10,000). The incidence of TC increased significantly in tumor patients who received radiotherapy/chemotherapy before age 35. The age at diagnosis of the SPTC was much older than the primary TC (64.01 vs. 49.55 years, p < 0.001). The SPTC had a higher percentage of histological grades 3/4 (23.14% vs. 15.19%, p < 0.001). Survival analyses demonstrated a worse prognosis for the SPTC group compared to the primary TC group. But after PSM, the survival outcomes of the two groups tended to be equivalent (P = 0.584). The SIRs of TC are higher in tumor patients. The most significant factors contributing to the increased risk of SPTC were some specific former tumors and acceptance of radiotherapy/ chemotherapy before age 35. There was no significant difference in survival between SPTC and primary TC.

The survival after thyroidectomy versus lobectomy in multifocal papillary thyroid microcarcinoma patients.

BACKGROUND: The extent of thyroid surgery for multifocal papillary thyroid microcarcinoma (PTMC) remains controversial. Studies on the optimal surgical approach for a multifocal PTMC are scarce. This study aimed to compare the effectiveness of thyroidectomy and lobectomy for the treatment of multifocal PTMC. METHODS: A population-based retrospective cohort of patients with multifocal PTMC was analyzed using the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2017, and divided into two groups (thyroidectomy, lobectomy) based on the surgical approach. The clinicopathologic features and survival outcomes were compared between the two groups. Cox proportional hazards regression analysis to explore prognostic factors of survival. Propensity score matching (PSM) was used to balance covariates. RESULTS: Overall, a total of 9387 multifocal PTMC patients were included in the study. Among them, 8,107 (86.36%) patients received thyroidectomy, and 1280 (13.64%) patients underwent lobectomy. Compared to patients in the thyroidectomy group, patients in the lobectomy group were diagnosed with older age (50.47 years vs. 49.32 years, p = 0.003), a higher proportion of males (20.47% vs. 14.99%, p < 0.001), larger tumors (6.22 mm vs. 4.97 mm, p < 0.001), and more frequently underwent radiotherapy (35.40% vs. 10.16%, p < 0.001). Multivariate Cox regression analysis revealed that age was the only independent prognostic factor for thyroid cancer-specific survival (TCSS), and the determinants of overall survival (OS) were age and gender. Unadjusted survival analysis revealed no difference between the two treatment groups in TCSS (p = 0.598) and OS (p = 0.126). After 1:1 Propensity Score Matching (PSM), there was still no difference in TCSS (p = 0.368) or OS (p = 0.388). The stratified analysis revealed that for patients aged under or above 55, thyroidectomy was not associated with superior BCSS or OS (p > 0.05). CONCLUSIONS: Thyroidectomy was not associated with improved survival compared to thyroid lobectomy for patients with multifocal PTMC.

An improved differential evolution algorithm for multi-modal multi-objective optimization.

Multi-modal multi-objective problems (MMOPs) have gained much attention during the last decade. These problems have two or more global or local Pareto optimal sets (PSs), some of which map to the same Pareto front (PF). This article presents a new affinity propagation clustering (APC) method based on the Multi-modal multi-objective differential evolution (MMODE) algorithm, called MMODE_AP, for the suit of CEC'2020 benchmark functions. First, two adaptive mutation strategies are adopted to balance exploration and exploitation and improve the diversity in the evolution process. Then, the affinity propagation clustering method is adopted to define the crowding degree in decision space (DS) and objective space (OS). Meanwhile, the non-dominated sorting scheme incorporates a particular crowding distance to truncate the population during the environmental selection process, which can obtain well-distributed solutions in both DS and OS. Moreover, the local PF membership of the solution is defined, and a predefined parameter is introduced to maintain of the local PSs and solutions around the global PS. Finally, the proposed algorithm is implemented on the suit of CEC'2020 benchmark functions for comparison with some MMODE algorithms. According to the experimental study results, the proposed MMODE_AP algorithm has about 20 better performance results on benchmark functions compared to its competitors in terms of reciprocal of Pareto sets proximity (rPSP), inverted generational distances (IGD) in the decision (IGDX) and objective (IGDF). The proposed algorithm can efficiently achieve the two goals, i.e., the convergence to the true local and global Pareto fronts along with better distributed Pareto solutions on the Pareto fronts.

Comparative Efficacy and Acceptability of 12 Phosphorus-Lowering Drugs in Adults with Hyperphosphatemia and Chronic Kidney Disease: A Systematic Review and Network Meta-Analysis.

BACKGROUND: Hyperphosphatemia is associated with cardiovascular morbidity and mortality in adults with chronic kidney disease (CKD). Drug therapy has an irreplaceable role in the management of hyperphosphatemia. OBJECTIVES: We aimed to compare and rank phosphorus-lowering drugs, including phosphate binder and nonphosphate binder, in hyperphosphatemia adults with CKD. METHODS: We did a systematic review and frequentist random-effect network meta-analysis. We searched in PubMed, Cochrane Library, Web of Science, and Embase from inception to February 1, 2023, for randomized controlled trials of 12 phosphorus-lowering drugs in adults with hyperphosphatemia and CKD. Primary outcomes were efficacy (changes in serum phosphorus) and acceptability (treatment withdrawals due to any cause). We ranked each drug according to the value of surface under the cumulative ranking curve. We applied the Confidence in Network Meta-Analysis frameworks to rate the certainty of evidence. This study was registered with PROSPERO, number CRD42022322270. RESULTS: We identified 2,174 citations, and of these, we included 94 trials comprising 14,459 participants and comparing 13 drugs or placebo. In terms of efficacy, except for niacinamide, all drugs lowered the level of serum phosphorus compared with placebo, with mean difference ranging between -1.61 (95% credible interval [CrI], -2.60 to -0.62) mg/dL for magnesium carbonate and -0.85 (-1.66 to -0.05) mg/dL for bixalomer. Only ferric citrate with odds ratios 0.56 (95% CrI: 0.36-0.89) was significantly associated with fewer dropouts for acceptability. Of the 94 trials, 43 (46%), 7 (7%), and 44 (47%) trials were rated as high, moderate, and low risk of bias, respectively, the certainty of the evidence was moderate to very low. CONCLUSIONS: Magnesium carbonate has the best phosphorus-lowering effect in hyperphosphatemia adults with CKD; considering efficacy and acceptability, ferric citrate shows evidence to be the most appropriate drug with or without dialysis.

Entropy: An Inspiring Tool for Characterizing Turbulence-Combustion Interaction in Swirling Flames via Direct Numerical Simulations of Non-Premixed and Premixed Flames.

This article focuses on entropy generation in the combustion field, which serves as a useful indicator to quantify the interaction between turbulence and combustion. The study is performed on the direct numerical simulations (DNS) of high pressure non-premixed and premixed swirling flames. By analyzing the entropy generation in thermal transport, mass transport, and chemical reactions, it is found that the thermal transport, driven by the temperature gradient, plays a dominant role. The enstrophy transport analysis reveals that the responses of individual terms to combustion can be measured by the entropy: the vortex stretching and the dissipation terms increase monotonically with the increasing entropy. In high entropy regions, the turbulence behaves as the "cigar shaped" state in the non-premixed flame, while as the axisymmetric state in the premixed flame. A substantial increase in the normal Reynolds stress with the entropy is observed. This is due to the competition between two terms promoted by the entropy, i.e., the velocity-pressure gradient correlation term and the shear production term. As a result, the velocity-pressure gradient correlation tends to isotropize turbulence by transferring energy increasingly from the largest streamwise component to the other smaller normal components of Reynolds stress and is dominated by the fluctuating pressure gradient that increases along the entropy. The shear production term increases with the entropy due to the upgrading alignment of the eigenvectors of strain rate and Reynolds stress tensors.

Efficacy and safety of tenapanor in hemodialysis patients with hyperphosphatemia: A systematic review and meta-analysis of randomized placebo-controlled trials.

BACKGROUND: The effects of tenapanor in reducing serum phosphorus in hemodialysis patients with hyperphosphatemia are uncertain and no relevant meta-analysis has been conducted. We performed a meta-analysis of randomized placebo-controlled trials to evaluate the efficacy and safety of tenapanor. METHODS: All randomized controlled trials of tenapanor were searched up to 1 August 2022. The primary endpoint was the change in serum phosphorus level from baseline with tenapanor and placebo. Data on drug-related adverse events (AEs), gastrointestinal AEs and diarrhea were collected to determine the safety of tenapanor. RESULTS: There were 533 patients throughout five trials that were eligible. Tenapanor significantly lowered blood phosphorus level by 1.79 mg/dl in the mean difference than the placebo. Diarrhea, gastrointestinal AEs, and drug-related AEs were more severe than placebo. CONCLUSIONS: This meta-analysis showed that although drug side effects were common, tenapanor significantly reduced serum phosphorus level in hemodialysis patients.

First Hard X-Ray Imaging Results by Solar Orbiter STIX.

The Spectrometer/Telescope for Imaging X-rays (STIX) is one of six remote sensing instruments on-board Solar Orbiter. The telescope applies an indirect imaging technique that uses the measurement of 30 visibilities, i.e., angular Fourier components of the solar flare X-ray source. Hence, the imaging problem for STIX consists of the Fourier inversion of the data measured by the instrument. In this work, we show that the visibility amplitude and phase calibration of 24 out of 30 STIX sub-collimators has reached a satisfactory level for scientific data exploitation and that a set of imaging methods is able to provide the first hard X-ray images of solar flares from Solar Orbiter. Four visibility-based image reconstruction methods and one count-based are applied to calibrated STIX observations of six events with GOES class between C4 and M4 that occurred in May 2021. The resulting reconstructions are compared to those provided by an optimization algorithm used for fitting the amplitudes of STIX visibilities. We show that the five imaging methods produce results morphologically consistent with the ones provided by the Atmospheric Imaging Assembly on board the Solar Dynamic Observatory (SDO/AIA) in UV wavelengths. The χ 2 values and the parameters of the reconstructed sources are comparable between methods, thus confirming their robustness.

Factors Influencing Delayed Treatment in Patients With Breast Cancer During COVID-19 Pandemic.

Background: The outbreak of coronavirus disease 2019 (COVID-19) has endangered human health and life. This pandemic has changed people's lifestyle and affected the regular delivery of standard cancer treatment. In the present study, we aimed to explore the influencing factors of delayed treatment in patients with breast cancer during COVID-19 pandemic. Methods: This study was a cross-sectional investigation, and the subjects were patients who were discharged from the department of burn and plastic surgery after February 2020. All participants completed this study's online questionnaire based on the WeChat and Wenjuanxing platforms. Levels of anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Patients were divided into a delay group and non-delay group according to the occurrence of delayed treatment. Univariate analysis was performed by using the t test or chi-square test. A logistic regression model was employed to determine factors associated with delayed treatment. Results: The present study included a total of 397 patients with breast cancer, among whom delayed treatment occurred in 76 patients, accounting for 19.1%. Scores on both the anxiety subscale and depression subscale in delay group were significantly higher than those in non-delay group. Compared with non-delay group, we found that patients in delay group usually had a higher level of education (P = 0.020), worse self-feeling (P = 0.030), poor compliance of medical order (P = 0.042), and a higher prevalence of anxiety (P = 0.004) and depression (P = 0.012). Traffic inconvenience was also an important relevant factor for delayed treatment (P = 0.001). The prevalence of recurrence in delay group was higher than that in non-delay group (P = 0.018). By using logistic multivariate regression analysis, the results revealed that level of education and traffic inconvenience were independent factors influencing delayed treatment in patients with breast cancer during COVID-19 pandemic. Conclusion: The prevalence of delayed treatment in patients with breast cancer during COVID-19 pandemic is relatively high. Our findings reveal several influencing factors closely associated with delayed treatment, which is useful information that will be beneficial for patients to receive standardized therapy by taking targeted measures.

Preoperative prediction of central lymph node metastasis in cN0T1/T2 papillary thyroid carcinoma: A nomogram based on clinical and ultrasound characteristics.

BACKGROUND: Preoperative status of central lymph nodes is a key determinant of the initial surgical extent for papillary thyroid carcinoma (PTC). We aimed to develop and validate a nomogram based on preoperative clinical characteristics and ultrasound features to predict central lymph node status in patients with clinically lymph node-negative (cN0) T1/T2 PTC. METHODS: This retrospective study included 729 patients with cN0T1/T2 PTC who were treated between January 2015 and March 2020. Based on the ratio of 6:4, 431 patients who underwent surgeries relatively earlier comprised the training set to develop the nomogram, while the other 298 who underwent surgeries relatively later comprised validation set to validate the performance of nomogram. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to identify predictors of central lymph node metastasis (CLNM). These variables were used to construct a nomogram for predicting the risk of CLNM. The predictive performance, discriminative ability, calibration, and clinical utility of the nomogram model were evaluated in both sets. RESULTS: A total of 313 (42.9%) PTC patients were identified with CLNM. On multivariate logistic regression analyses, malegender, younger age, larger maximum diameter, multifocality, capsular invasion, infiltrative margins, intra-nodular vascularity, and aspect ratio >1 were independent risk factors for CLNM. Nomogram integrating these 8 factors showed excellent discrimination in the training [area under the curve (AUC): 0.788] and validation (AUC: 0.829) sets, and obtained well-fitted calibration curves. The cut-off value of this nomogram was 0.410 (∼245 points). Decision curve analysis confirmed the clinical utility of the nomogram. CONCLUSION: The CLNM-predicting nomogram can facilitate stratification of cN0T1/T2 PTC patients. Prophylactic central neck lymph node dissection can be considered for those with high nomogram scores.

Expression of Snail and E-cadherin in Drug-resistant MCF-7/ADM Breast Cancer Cell Strains.

OBJECTIVE: To investigate the expression of zinc finger transcription factors-Snail and E-cadherin in adriamycin-resistant human breast cancer MCF-7/ADM cells and non-resistant MCF-7 cells. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Cancer Hospital, and Jiangsu Institute of Cancer Research, China, from April 2017 to March 2018. METHODOLOGY: Real-time quantitative PCR technology was used to detect the expression levels of Snail mRNA and E-cadherin mRNA in normal breast cells, adriamycin-resistant human breast cancer MCF-7/ADM cells and non-resistant MCF-7 cells. Western blot was used to detect the expression levels of proteins of Snail and E-cadherin in normal breast cells, adriamycin-resistant human breast cancer MCF-7/ADM cells and non-resistant MCF-7 cells. RESULTS: The expression of Snail mRNA and protein in adriamycin-resistant human breast cancer MCF-7/ADM cells was significantly higher than that in normal breast cells (p<0.001) and non-resistant MCF-7 cells (p<0.001). The expression of E-cadherin mRNA and protein in adriamycin-resistant human breast cancer MCF-7/ADM cells was significantly lower than that in normal breast cells (p<0.001) and non-resistant MCF-7 cells (p<0.001). CONCLUSION: Adriamycin-resistant human breast cancer MCF-7/ADM cell strains had high expression of Snail and low expression of E-cadherin. This points out to a new research direction for the targeted therapy of drug-resistant breast cancer cells, and provides clinical guidance for breast cancer therapy and prognosis evaluation.